Initial Notice of COBRA Rights

The Initial Notice can be provided to employees to sign and acknowledge receipt at time of hire, and should also be mailed to the employee's spouse/dependents. The Proof of Mailing form can be used by management to document that the Notice was mailed and should be filed with the employee's personnel documentation.

Be sure to check if your state may have additional state-specific COBRA requirements.

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Federal Initial Notice of COBRA Rights - Form Reference #1.ONBC.3039.01

California Initial Notice of COBRA Rights - Form Reference #1.ONBC.3039.01CA