The Department of Labor has released sample notices employers may use to meet their obligations related to the COBRA subsidy available through the American Rescue Plan (ARP) Act of 2021:

  • Model General Notice and COBRA Continuation Coverage Election Notice: MS Word | PDF  Also available in Spanish MS Word | PDF –  For use by group health plans for qualified beneficiaries who have qualifying events occurring from April 1, 2021 through September 30, 2021
  • Model Notice in Connection with Extended Election Period: MS Word | PDF  Also available in Spanish MS Word | PDF –  For use by group health plans for qualified beneficiaries currently enrolled in COBRA continuation coverage, due to a reduction in hours or involuntary termination (Assistance Eligible Individuals), as well as those who would currently be Assistance Eligible Individuals if they had elected and/or maintained COBRA continuation coverage
  • Model Alternative Notice: MS Word | PDF  Also available in Spanish MS Word | PDF –  For use by insured coverage subject to state continuation requirements between April 1, 2021 and September 30, 2021. Employers should check with their insurance carriers on the process to be used for state continuation coverage (“mini-COBRA”)
  • Model Notice of Expiration of Premium Assistance: MS Word | PDF  Also available in Spanish MS Word | PDF –  For use by group health plans to Assistance Eligible Individuals 15-45 days before their premium assistance expires
  • Summary of COBRA Premium Assistance Provisions under the American Rescue Plan Act of 2021: MS Word | PDF  Also available in Spanish MS Word | PDF – This should be included and sent with each copy of the Model General/Election Notice, Notice in Connection with Extended Election Period, and Model Alternative Notice.

Additional Resources:

 

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