COBRA Payment Screen





 

Parameter Name

Function

Required
Month This is month that the payment applies to. Yes
Year This is the year that the payment applies to. Yes
Amount This is the amount that was recieved. Yes
Rec Date This is the date the payment was recieved. Optional
Comments Miscellaneous comments relating to the COBRA payment may be entered here. This text entry line has maximum length of 20 characters. Optional


 

Button Name

Function
OK This button closes the COBRA Payment Screen, saving the entered information, returning you to the COBRA Coverage History Panel. 
Cancel This button closes the COBRA Payment Screen, without saving the entered information, returning you to the COBRA Coverage History Panel.