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Extended Coverage/COBRA Election Notice Date of Notice (Benefits Administrator/BA should provide information noted in red instructions to BA are highlighted)Name and Address: To the former employee

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What is date of notice benefits?

Date of notice benefits is the date on which an employee gives notice of their intent to claim benefits.

Who is required to file date of notice benefits?

Employees who are planning to claim benefits are required to file date of notice benefits.

How to fill out date of notice benefits?

Date of notice benefits can be filled out by submitting a written notice to the appropriate department.

What is the purpose of date of notice benefits?

The purpose of date of notice benefits is to inform the relevant department of an employee's intent to claim benefits.

What information must be reported on date of notice benefits?

Date of notice benefits must include details such as employee name, employee ID, date of notice, and type of benefits being claimed.