- Model General Notice and COBRA Continuation Coverage Election Notice
- For use by group health plans for qualified beneficiaries who have qualifying events
occurring from April 1, 2021 through September 30, 2021 - A summary of the subsidy provisions is to be attached and includes a form for individuals
to request to be treated as an AEI OR give notice of eligibility for other coverage.
- For use by group health plans for qualified beneficiaries who have qualifying events
- Model Notice in Connection with Extended Election Period
- For use by group health plans for qualified beneficiaries currently enrolled in COBRA
continuation coverage, due to a reduction in hours or involuntary termination
(Assistance Eligible Individuals), as well as those who would currently be Assistance
Eligible Individuals if they had elected and/or maintained COBRA continuation coverage
- For use by group health plans for qualified beneficiaries currently enrolled in COBRA
- Model Notice of Expiration of Premium Assistance
- For use by group health plans to Assistance Eligible Individuals
15-45 days before their premium assistance expires
- For use by group health plans to Assistance Eligible Individuals
Model notices were published on April 7, 2021 and are available of the Department of Labor website at:
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/cobra/premium-subsidy
