Contact Us | 585-244-1800
Below are model notices provided by the U.S. Department of Labor that can be used to notify your terminated employees of COBRA eligibility. Additional information can also be obtained from the U.S. Department of Labor website (click here).

General COBRA Notice - For use by employees currently enrolled in COBRA to advise them of the availability of the premium reduction.

Extended Election Notice - For use by employees who are or would be an Assistance Eligible Individual but not enrolled in COBRA including those who elected but subsequently discontinued coverage.

COBRA Election Notice - For use by employees terminated since Feb. 17, 2009.

Premium Reduction Form - This link contains the subsidy application only. This form is also included in the notices above.

Summary of Premium Reduction Provisions

COBRA Premium Reduction Fact Sheet

home | contact us | site map | privacy

© Rochester Business Alliance 150 State Street Suite 400, Rochester, NY 14614-1308
Ph: 585.244.1800 Fax: 585.263.3679
Powered by NimbleUser.