Cobra Termination Notice Sample Letter at Sample Letters

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Cobra Termination Notice Sample Letter. Employers should use this letter to notify cobra participants, including a covered spouse and covered dependents, if applicable, that their cobra coverage will terminate due to expiration of the cobra. The department of labor has developed a model consolidated omnibus budget reconciliation act of 1985 (cobra) continuation coverage election notice that the plan may use to provide the election notice.

Model COBRA Continuation Coverage General Notice

Box 657 columbia, mo 65205 9/29/2020 general notice of your rights group health continuation coverage under cobra this letter is for your information only. Such a notice should explain the reason coverage has terminated, provide the date of termination. This letter may be customized.

Model COBRA Continuation Coverage General Notice

The termination or reduction of hours of the covered employee’s employment for other than gross. Sample cobra notice abc company c/o the cobra administrator’s name 1234 south st city, state and zip 06/10/2008 pqb name: 2021 notice of cobra asi cobra p.o. Sample initial general cobra notice date of notice: