COBRA Continuation Coverage Election Form - Digital
An attorney-reviewed digital form to comply with mandatory health insurance notice requirements under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), an individual who was covered by a group health plan on the day before the occurrence of a qualifying event (such as a termination of employment or a reduction in hours that causes loss of coverage under the plan) may be able to elect COBRA continuation coverage upon that qualifying event. Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights.
The COBRA Continuation Coverage Election Notice must be provided when an employee who was covered by a group health plan experiences a “qualifying event,” such as termination of employment. Qualifying events are certain events that would cause an individual to lose health coverage under a group health plan.
Our digital, attorney-reviewed COBRA Continuation Coverage Election Notice Form is designed to comply with election notice requirements. It includes critical provisions of the American Rescue Plan Act (ARPA), which provides temporary COBRA premium assistance during the pandemic.
Features & Benefits Include:
- A digital notice form to be completed by the employer and the eligible employee (or the employee’s spouse or beneficiary);
- Attorney-reviewed to ensure compliance with COBRA notice requirements and the American Rescue Plan Act (ARPA);
- Printable, fill-in-the-blanks digital format for physical or electronic recordkeeping;
- A detailed instruction sheet explaining how & when to use the form and how long to retain it.
Our attorney-reviewed form is designed to help employers:
- Fulfill mandatory notice requirements under COBRA when a qualifying event occurs.
- Document plan participant elections for continuation of health coverage.
- If you are not completely satisfied, you can cancel your order within seven (7) days of receipt for a full refund.