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Resignation Notice Current Employee Current Date: Employee Full Name: Employee Number: (4 tor 6 numbers) Department/Division: Title: Reason for Leaving: (Circle One) Personal Email: (for Cobra Insurance
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01
Contact your employer or benefits administrator to get the necessary forms.
02
Complete the required information on the forms, including personal details, dates of coverage, and reason for coverage.
03
Return the completed forms to the appropriate party within the specified timeframe.

Who needs how to administer cobra?

01
Employees who are leaving or have left their job and want to continue their health insurance coverage under COBRA.
02
Spouses and dependents who were covered under the employee's health insurance plan and want to continue their coverage.
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COBRA, or the Consolidated Omnibus Budget Reconciliation Act, is a federal law that requires employers with 20 or more employees to offer continued health coverage to employees and their dependents who would otherwise lose coverage due to certain qualifying events.
Employers with 20 or more employees who offer group health insurance coverage are required to comply with COBRA regulations and offer continued coverage to eligible individuals.
Employers must provide individuals with notice of their COBRA rights, allow them to elect continuation coverage, and collect premiums for the coverage.
The purpose of COBRA is to provide employees and their dependents with the option to continue their health coverage when they would otherwise lose it due to qualifying events like termination of employment or reduction in hours.
Employers must provide information about the coverage options available, the cost of the coverage, the rights of eligible individuals, and how to elect continuation coverage.
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