Notice of Right to Elect (aka COBRA Notice)
After receiving a notice of a qualifying event, the plan must provide the qualified beneficiaries with an election notice, which describes their rights to continuation coverage and how to make an election. The election notice must be provided to the qualified beneficiaries within 14 days after the plan administrator receives the notice of a qualifying event The election notice should include: The name of the plan and the name, address, and telephone number of the plan’s COBRA administrator; Identification of the qualifying event; Identification of the qualified beneficiaries (by name or by status); An explanation of the qualified beneficiaries’ right to elect continuation coverage; The date coverage will terminate (or has terminated) if continuation coverage is not elected; How to elect continuation coverage; What will happen if continuation coverage isn’t elected or is waived; What continuation coverage is available, for how long, and (if it is for less than 36 months), how it can be extended for disability or second qualifying events; How continuation coverage might terminate early; Premium payment requirements, including due dates and grace periods; A statement of the importance of keeping the plan administrator informed of the addresses of qualified beneficiaries; and A statement that the election notice does not fully describe COBRA or the plan and that more information is available from the plan administrator and in the SPD.
The Department has developed a model election notice that plans may use to satisfy their obligation to provide the election notice. The model election notice is available at dol.gov/ebsa. In order to use this model election notice properly, the plan administrator must complete it by filling in the blanks with the appropriate plan information. The Department will consider use of the model election notice, appropriately completed, good faith compliance with the election notice content requirements of COBRA.
The Department has developed a model election notice that plans may use to satisfy their obligation to provide the election notice. The model election notice is available at dol.gov/ebsa. In order to use this model election notice properly, the plan administrator must complete it by filling in the blanks with the appropriate plan information. The Department will consider use of the model election notice, appropriately completed, good faith compliance with the election notice content requirements of COBRA.
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