COBRA PREMIUM SUBSIDY NOTIFICATION As a result of the enactment of The American Recovery and Reinvestment Act of 2009 commonly referred to as the “Stimulus Bill” you may have the r by wka21287

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									                COBRA PREMIUM SUBSIDY NOTIFICATION
As a result of the enactment of The American Recovery and Reinvestment Act
of 2009 (commonly referred to as the “Stimulus Bill”) you may have the right to
have 65% of your COBRA premium paid on your behalf.


Am I eligible and if so, how do I get the subsidy?
You are eligible if you:
    •    were terminated from your job involuntarily (or you are the spouse or dependent child of a covered
         employee who was terminated involuntarily),See Note 1
    •    are not eligible for other group health plan coverage,See Note 2 and,
    •    elect to continue the employer-provided coverage under COBRA.
In order to receive the subsidy you must:
    (1) Elect COBRA within the 60 day time period noted on the enclosed Election Notice, AND,
    (2) Submit 35% of the full COBRA premium indicated on the enclosed Election Notice by
        the payment due date. [You will have 45 days to pay after electing COBRA. You may
        pay using ADP’s BeneDirect website (www.BeneDirect.ADP.com), using the coupon
        you will receive from ADP, or by sending your payment to the address provided.]
In addition, the employer whose health plan in which you are enrolling must verify that you should receive
the subsidy.
Please note that you must list the name(s) of ineligible individuals on the enclosed COBRA PREMIUM
SUBSIDY INELIGIBLITY FORM and submit to ADP. For example, if the former employee’s spouse is
electing COBRA but is eligible for other group health plan coverage See Note 2 then the spouse is not eligible
for the premium subsidy and should be listed on the form.
NOTE 1: The termination of employment must have occurred during the period starting on September 1, 2008 through
December 31, 2009.

How long can I receive the subsidy?
The subsidy is available until the earliest of the following:
    •    The first day of the month following the 9th month you have received the subsidy.
    •    The first date that you become ELIGIBLE for coverage under any other group health plan except as
         noted below. See Note 2
    •    The date which you become ineligible for COBRA coverage for any reason, including exhaustion of
         COBRA or failure to pay the required premium on time.
NOTE 2: Eligibility for coverage that is only dental, vision, counseling, or referral services or coverage under a health
flexible spending arrangement or coverage of treatment that is provided at an employer on-site medical facility will not result
in your disqualification for the subsidy.



What if I become eligible for other group health plan coverage? See Note 2
It is your responsibility (under Federal law) to notify the group health plan that you are no longer eligible to
receive the subsidy. Failure to do so may result in a penalty being assessed against you in the amount of 110
percent of any subsidy received while you were not eligible to receive the subsidy.




ARRA Subsidy Insert Post Signing                          Page 1 of 3                                           20090220A_WM
What if I already have a subsidy?
The former employer offering subsidies prior to enactment of this legislation may decide to change their subsidy
offering. However, if you are eligible as defined by the sections above, then you will receive at a minimum a 65
percent premium subsidy for the length of time prescribed.



Are there income limitations?
If your modified adjusted gross income in any year in which the subsidy is received exceeds $145,000 (if you file as a single
individual) or $290,000 (if married and filing jointly), you are not eligible for the subsidy at all. If your modified adjusted gross
income in any year in which the subsidy is received is between $125,000 and $145,000 (if filing single) or is between
$250,000 and $290,000 (if married and filing jointly), you may receive a partial subsidy.
If you anticipate that your modified adjusted gross income for any year in which you are otherwise eligible to receive the
subsidy will exceed the limits, you may waive your rights to the subsidy by signing the IRREVOCABLE WAIVER OF
SUBSIDY on the enclosed COBRA PREMIUM SUBSIDY WAIVER FORM and submit to ADP.

CAUTION: If you fail to waive your rights to the subsidy and your modified adjusted gross income exceeds the limits, you will
owe an additional tax on your Federal tax return equal to the amount of the subsidy that you were not entitled to receive.



Where do I get additional information?
As you know, this legislation was just signed into law on February 17, 2009. It will take time for employers and
ADP as a representative of employers to get everything in place to carry this forward. Even though you may not
have paperwork in your hands today showing you exactly what your new premium amount is, rest assured that if
you are eligible, you will get the subsidized premium. In the meantime if you have questions, the fastest means
to find answers is to visit our website at:

                                           www.BeneDirect.ADP.com
Or you may also contact us at:                ADP Benefit Services
                                              P.O. Box 2968
                                              Alpharetta, GA 30023-2968
                                              1-800-522-6621




ARRA Subsidy Insert Post Signing                             Page 2 of 3                                             20090220A_WM
If you are eligible for the subsidy you only need to elect using the COBRA CONTINUATION
COVERAGE FORM enclosed in this package. Use this form only to opt out of the subsidy.


         COBRA PREMIUM SUBSIDY INELIGIBLITY FORM
Please list the individual(s) who have elected COBRA continuation coverage but are NOT eligible for the
COBRA premium subsidy due to their eligibility for other group health coverage.

       PLEASE PRINT CLEARLY

       ______________________________                         ______________________________

       ______________________________                         ______________________________

       ______________________________                         ______________________________

I understand that by signing below, the individuals listed above will not receive the COBRA premium subsidy.
(NOTE: If you do not sign below this form cannot be processed.)

____________________________________                                  _______________________
Print Name                                                            BL# from Election Form

____________________________________                                  ____________________
Signature                                                             Date

____________________________________
Employer Name




               COBRA PREMIUM SUBSIDY WAIVER FORM
IRREVOCABLE WAIVER OF SUBSIDY. The undersigned irrevocably waive any right to a COBRA premium
subsidy because of anticipated modified adjusted gross income in excess of the allowable limits for availability
of the COBRA premium subsidy. This waiver is permanent and irrevocable.
(NOTE: Individuals listed below without signatures below cannot be processed.)

____________________________________                                  ____________________
Print Name                                                            BL# from Election Form

____________________________________                                  ____________________
Signature (Former Employee)                                           Date

____________________________________
Print Name (Spouse)

____________________________________                                  ____________________
Signature (Spouse)                                                    Date

____________________________________
Employer Name




ARRA Subsidy Insert Post Signing                        Page 3 of 3                                 20090220A_WM

								
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