Revised Compliance Notice Forms Package Now Available

May 12, 2009

As a result of the American Recovery and Reinvestment Act of 2009, your COBRA notices and forms will have to be revised to reflect the COBRA Premium Assistance Subsidy. I revised my COBRA Notice Compliance Forms Package to reflect these new changes and to add new required forms.

My revised COBRA Notice Compliance Forms Package includes the following notices,

forms and explanations:

  • An Explanation of the COBRA rules,
  • A Sample Initial COBRA Notice,
  • A Sample COBRA Insert for Summary Plan Description,
  • A Sample Election Notice, Election Form and Attachments,
  • A Sample Application for the COBRA Premium Assistance Subsidy with Attachments,
  • A Sample Notice of Eligibility for Other Group Insurance Coverage or Medicare,
  • A Sample COBRA Premium Assistance Subsidy Waiver Notice Form,
  • A Sample Notice of Qualifying Events from the Employer,
  • A Sample Notice of Qualifying Events from Covered Employees and Qualified Beneficiaries,
  • A Sample Notice of Unavailability of COBRA Coverage, and
  • A Sample Notice of Termination of COBRA Coverage.

The entire revised COBRA Notice Compliance Forms Package is available now for only $400.  To order, please follow the directions contained below.

Questions and Order Information

Please contact me at or 708-717-9638 with any questions or samples.

Click here to download and print the ORDER FORM