COBRA Premium Increase Notice

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COBRA Premium Increase Notice Powered By Docstoc
					COBRA Premium Increase
Notice
This notice courteously informs the employees of a small business that healthcare
premiums and COBRA premiums are increasing for the next fiscal year. Under COBRA,
small businesses are allowed to pass any change in premiums at the beginning of each
coverage period. Customize the information of the parties, the coverage dates, the
amount of increase, and more. This notice is ideal for small businesses or other entities
that want to inform employees of an increase in healthcare premiums.
                ________________ [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:      Notice of COBRA Premium Increase

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

        As you may be aware, ___________________ [Instructions: Insert the Company’s
name] (“Company”) purchases health plan coverage and premium rates that renew annually on
the ______________________ [Instructions: Insert the day number] day of
___________________ [Instructions: Insert the month] of each year (the “Renewal Date”) and
remains in effect until the following Renewal Date (the “Coverage Period”). Due to the
increasing cost of health care, the Company’s health premiums for the upcoming Coverage
Period are increasing by approximately ___________ percent (___%), [Instructions: Insert
Percentage] effective as of the Renewal Date.

       Under the Consolidated Omnibus Budget Reconciliation Act (“COBRA”), the Company
is permitted to pass any change in premiums for COBRA participants at the beginning of each
Coverage Period. Under COBRA, the Company may charge COBRA participants one hundred
two percent (102%) of the total cost of coverage for active employees, which takes into account
the Company’s reasonable COBRA administration fee. Accordingly, effective as of the Renewal
Date, your new COBRA premium, will be ___________ Dollars $(___) [Instruction: Insert the
amount] per month.

       Please be sure to pay your premiums, in full and on time, to avoid termination of COBRA
coverage. Should you have any questions about the foregoing, please do not hesitate to contact
me.

                                                        Very truly yours,



                                                        _________________, [Instructions: Insert name]
                                                        COBRA Plan Administrator for ___________
                                                        [Instructions: Insert the Company’s name]




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DOCUMENT INFO
Description: This notice courteously informs the employees of a small business that healthcare premiums and COBRA premiums are increasing for the next fiscal year. Under COBRA, small businesses are allowed to pass any change in premiums at the beginning of each coverage period. Customize the information of the parties, the coverage dates, the amount of increase, and more. This notice is ideal for small businesses or other entities that want to inform employees of an increase in healthcare premiums.