LEGAL NOTICES
COBRA
Model General Notice of COBRA Continuation Coverage Rights (For use by single-employer group health plans)
** Continuation Coverage Rights Under COBRA**
Introduction
You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has import ant
information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice
explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to
protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may
cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage
would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review
the Plan’s Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an
individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower
costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept la te enrollees.
What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also
called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA co ntinuation
coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children coul d
become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries
who elect COBRA continuation must pay for COBRA continuation coverage.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the followin g qualifying
events:
• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.
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MOTHER BENEFITS GUIDE
LEGAL NOTICES I
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