Shop OurSolutions  ►
Priority Number

COBRA Continuation Coverage Election Notice - Downloadable Form


Mandatory form explains COBRA Health Benefits choices

Fully comply with healthcare requirements with this form listing employees’ additional COBRA health insurance options. The notice lists COBRA coverage choices for qualified beneficiaries under the Affordable Care Act (ACA). It tells employees about Marketplace options that are potentially less costly than COBRA coverage and the difficulty of switching coverage after making a decision. Also includes information about health insurance exchanges and clarifies their role as a COBRA alternative.


Most recent update includes:

  • ACA restriction on preexisting conditions
  • Elimination of expired Health Coverage Tax Credit
  • Statement on eligibility of new tax credit that lowers monthly premiums
  • Enrollment information about additional eligible plans
  • Employees must receive within 14 days of notice of qualifying event
  • Describes employees’ COBRA continuation rights
  • Guaranteed to be up to date
  • Includes tip sheet

  • Instructions for downloading provided at checkout
  • Please note: downloadable forms are not returnable

Product Specifications:

  • Size: 8.5 " x 11"
  • Downloadable poster - English