COBRA Premium Assistance Notification Forms


You are no doubt familiar with the new COBRA premium assistance law enacted by President Obama on February 17, 2009 that enables involuntarily terminated employees to obtain insurance under your Company's health insurance plan, but pay only 35% of the premium.   The law requires that eligible employees are notified that premium assistance is available.  The law also requires the Secretary of Labor to create model forms no later than March 15, 2009.  However, you may wish to begin notifying employees of these rights sooner rather than later (which will start the clock running on the 60 day acceptance period sooner).

If your Company offers only the same health insurance under COBRA that it does to active employees, and you want to send out the notifications now, I have created two forms that I believe meet the notification requirements of the new law. They are in word format so you will be able to simply insert the appropriate contact information for your organization.

Please be advised that in using these forms, there is a possibility that they will differ from the model forms created by the Secretary of Labor, in which case, you may be required to send the new form once it has been created which will re-start the 60-day acceptance period.

The two forms (which only apply if your Company offers only the same insurance under COBRA as it does to active employees) are as follows:

COBRA Premium Assistance Notification Form for Previously Terminated Employees
(This form may be sent out along with your COBRA acceptance form and does not need to be accompanied by your current COBRA notification form.)

COBRA Premium Assistance Notification Form for Newly Terminated Employees
(This form should be attached to your existing COBRA notification form.)