The Plan Administrator has the obligation to send a COBRA Election Notice to each qualified beneficiary who will lose plan coverage as a result of a qualifying event. The Election Notice contains information about a qualified beneficiary’s continuation coverage rights and obligations with respect to a qualifying event, and is typically accompanied by a COBRA Election Form.192

The Plan Administrator must send out the Election Notice, which must contain the following 14 required items that must appear in the Election Notice,193 within 14 days of the time it receives notice that a qualifying event has occurred.194 They are:

  • plan name and address;
  • identification of the qualifying event;
  • identification of each qualified beneficiary and the date the plan coverage will terminate;
  • a statement regarding each qualified beneficiary’s independent right to elect COBRA continuation coverage;
  • an explanation of how to elect COBRA continuation coverage;
  • an explanation of the consequences of failing to elect COBRA continuation coverage;
  • a description of the COBRA continuation coverage;
  • an explanation of the duration of COBRA continuation coverage;
  • a description of the circumstances under which COBRA coverage may be extended;
  • a description of the plan’s requirements concerning a qualified beneficiary’s obligation to provide notice to the plan of a second qualifying event and notice of a Social Security disability determination, and related procedures;
  • a description of the COBRA premium amount;
  • a description of the plan’s COBRA premium payment procedures;
  • an explanation of the importance of qualified beneficiaries to keep the plan informed of current address; and
  • a statement that more complete information regarding COBRA continuation coverage rights is available from the Plan Administrator and from the plan SPD.

COBRA Election Notice Sample

Employers and Plan Administrators are cautioned that this Notice will require tailoring to the particular group health plan and that they should consult with legal counsel for revisions prior to use.

CREDITS: This is an excerpt from An Employer’s Guide to Employment Issues in Minnesota, provided by the Minnesota Department of Employment and Economic Development & Linquist & Vennum P.L.L.P., Tenth Edition, 2009. Copies are available without charge from the Minnesota Department of Employment and Economic Development, Small Business Assistance Office.

This post is also part of a series of posts covering the Continuation of Group Health and Life Insurance Coverage Law (COBRA). This information is not legal advice. You should consult with an experienced employment attorney before dealing with COBRA-related employment issues.

192 29 C.F.R. § 2590.606-4.
193 29 C.F.R. § 2590.606-4(b)(4).
194 29 C.F.R. § 2590.606-4(b); Preamble to Final DOL Regulations, 69 Fed Reg. 30083, 30091 (May 26, 2004).