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COBRA ELECTION FORM have read and understand the provisions of the Consolidated Omnibus Budget Reconciliation Act (C.O.B.R.A.) Notice provided to me in the Continuation Coverage Rights which I have
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How to fill out general notice of cobra

01
Obtain the general notice of COBRA form from your employer or human resources department.
02
Fill out the employer's name, address, and telephone number.
03
Provide the name of the group health plan.
04
Include the start and end date of coverage for the qualified beneficiary.
05
Indicate the date of the qualifying event.
06
Explain the rights and obligations of the qualified beneficiary.
07
Sign and date the form.

Who needs general notice of cobra?

01
Employees who are eligible for COBRA coverage after experiencing a qualifying event.
02
Qualified beneficiaries such as spouses and dependents who are eligible for COBRA coverage.
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General notice of COBRA is a notice that must be provided to employees and their covered dependents explaining their rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA) when they experience a qualifying event that would result in the loss of their health insurance coverage.
Employers with 20 or more employees who offer group health insurance coverage are required to provide a general notice of COBRA to employees and their covered dependents.
The general notice of COBRA should include specific information such as the name of the group health plan, the name and contact information of the plan administrator, a description of COBRA rights, and instructions on how to elect continuation coverage.
The purpose of the general notice of COBRA is to inform employees and their covered dependents of their rights to continue their health insurance coverage under COBRA when they experience a qualifying event.
The general notice of COBRA must include information about the employee's rights to continue health insurance coverage, the cost of continuation coverage, and the deadlines for electing COBRA coverage.
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