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COBRA Notice of Coverage Continuation

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This notice informs employees that they are entitled to a subsidy from the federal government to assist with COBRA premiums. This subsidy is a result of recent change in federal law, namely the American Recovery and Reinvestment Act (ARRA) of 2009. In addition, the employee may be entitled to enroll in COBRA at a special rate if they are not already enrolled. This notice is ideal for small businesses or other entities that want to inform employees of a continuation in COBRA coverage.

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									COBRA Notice of Coverage
Continuation
This notice informs employees that they are entitled to a subsidy from the federal
government to assist with COBRA premiums. This subsidy is a result of recent change
in federal law, namely the American Recovery and Reinvestment Act (ARRA) of 2009.
In addition, the employee may be entitled to enroll in COBRA at a special rate if they are
not already enrolled. This notice is ideal for small businesses or other entities that want
to inform employees of a continuation in COBRA coverage.
                ________________ [Instructions: Insert the Company’s name]
         _____________________ [Instructions: Insert the Plan Administrator’s name]
         ______________________ [Instructions: Insert the Company’s address line 1]
         ______________________ [Instructions: Insert the Company’s address line 2]

                                                       _________________ [Instructions: Insert the date]

_____________________ [Instructions: Insert the Employee’s name]
_____________________ [Instructions: Insert the Employee’s address line 1]
_____________________ [Instructions: Insert the Employee’s address line 2]

         Re:      Supplemental Notice of COBRA Continuation Coverage

Dear ______________________, [Instructions: Insert the Employee’s name]

       Due to recent changes in the law, namely the American Recovery and Reinvestment Act
of 2009 (“ARRA”), as amended, you and your eligible dependents may be eligible for a subsidy
from the federal government to assist with your premiums for Consolidated Omnibus Budget
Reconciliation Act (“COBRA”) coverage. If you are eligible for the federal COBRA premium
subsidy and are not currently enrolled in COBRA, you and your eligible dependents may also
have a special enrollment opportunity to enroll in COBRA.

       The federal premium subsidy is available to any individual (former employee or eligible
dependent) that was covered by the group health plan of _____________________
[Instructions: Insert the Company’s name] (“Company”) who became eligible for COBRA
coverage because of an involuntary termination of employment that occurred between September
1, 2008 through May 31, 2010. The subsidy and special election opportunity are not available to
individuals whose COBRA qualifying event was not involuntary termination of employment –
for example, a loss of coverage due to divorce. It is also not available if the involuntary
termination of employment was due to gross misconduct.

        To help determine whether you are eligible, you should review the enclosed documents
carefully. The documents will provide you with details of your options and include forms that
allow you take advantage of the premium assistance and, if not already enrolled for COBRA, to
make a COBRA election. Please complete all applicable forms and return them to me as soon as
possible. Upon receipt, Company will review your completed forms and will notify you if you
qualify for the subsidy and, if applicable, special enrollment. Should you have any questions
about the foregoing, please do not hesitate to contact me.

Enclosure
                                                        Very truly yours,


                                                        ________________, [Instructions: Insert name]
                                                        COBRA Plan Administrator for ______________
                                                        [Instructions: Insert the Company’s name]



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