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Please read the Important Information section before proceeding.

COBRA

Appendix C - Part of the Summary Plan Description that should be given to employees to explain their continuation of coverage rights after the occurence of certain events that cause loss of group health coverage under the plan.

Notice of Second Qualifying Event - Use this form to provide notice of a COBRA second qualifying event.

Notice of Disability - Used when he Social Security Administration has determined that a qualified beneficiary was disabled on any day of the first 60 days of COBRA continuation coverage due to a qualifying event that was the covered employee's termination of employment or reduction of hours.

COBRA Election Notice

Notice of Qualifying Event - Use this form to provide notice of a COBRA qualifying event.

Notice Of Early Termination

Notice Of Other Coverage - Use this form to provide notice of other coverage, Medicare entitlement, or cessationof disability under COBRA.

Notice of Unavailability of COBRA Coverage