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COBRA Denial/Unavailability of Coverage Form - Digital

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A digital, attorney-reviewed notice form to help employers and their health benefits administrators comply with mandatory COBRA notice requirements when continuation coverage is denied or unavailable.


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.  In specific situations, however, a covered individual may be denied continuation coverage.  In such cases, employers must provide a Notice of Denial / Unavailability of COBRA Continuation Coverage to inform individuals of the unavailability of COBRA continuation coverage and provide the reasons why.


Our attorney-reviewed Notice of Denial / Unavailability of COBRA Continuation Coverage Form complies with mandatory notice requirements under COBRA when continuation coverage is denied or unavailable.  This notice must be provided within 14 days of the individual’s request for continuation coverage, and must include a reason for the denial or unavailability of coverage.


Features & Benefits Include:

  • A digital notice form to notify individuals in writing if COBRA continuation coverage is denied or unavailable;
  • Attorney-reviewed to ensure compliance with mandatory COBRA notice requirements;
  • 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:

  • Notify individuals in writing as required by COBRA that their request for COBRA continuation coverage has been denied or that coverage is unavailable. 
  • Comply with mandatory COBRA notice and recordkeeping requirements.


  • If you are not completely satisfied, you can cancel your order within seven (7) days of receipt for a full refund.
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