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COBRA General Notice Form - Digital

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An attorney-reviewed digital form to comply with mandatory notice requirements under the Consolidated Omnibus Budget Reconciliation Act (COBRA) when health insurance coverage begins.    


In general, 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. Employers must provide a General Notice of COBRA Continuation Coverage Rights to inform affected employees and their spouses of those rights under COBRA.


Our digital, attorney-reviewed General Notice of COBRA Continuation Coverage Rights Form meets COBRA notice requirements and should be provided to eligible individuals when health insurance coverage commences.   This form provides employees with important information about their rights related to possible continued health care coverage within the company’s group health plan, as well as other health coverage options that may be available to them, including coverage through Medicaid or the Health Insurance Marketplace.


Features & Benefits Include:

  • A digital notice form to be provided to the employee and their spouse (if applicable) at the time coverage commences as required by COBRA;
  • 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:

  • Comply with mandatory COBRA notice requirements informing employees and their spouses of their rights to continuation coverage when a qualifying event occurs. 
  • Fulfill documentation and recordkeeping requirements under COBRA. 


  • 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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