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Priority Number

Initial Notification COBRA Continuation Coverage Rights

A0011

Inform employees of their COBRA health coverage rights

Stay fully compliant by giving this COBRA coverage form to employees within 90 days of employees becoming covered under a group health plan. This notice explains just how long does COBRA last and includes information on Health Insurance Marketplace coverage options under the Patient Protection and Affordable Care Act (PPACA). It details special enrollment options and features a link to the Marketplace website.

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

Product Specifications:

  • Size: 8.5 " x 11"
  • Downloadable poster - English
  • Requires Adobe Acrobat 5 or later