Notice of COBRA Rights and Proof of Mailing COBRA Rights
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Note: This sample form is provided as a tool for employers. This form is general in nature, and may not be required by law. ManagEase is not a law firm. This form does not constitute legal advice, nor is any attorney-client relationship created or implied. Prior to using this form, we recommend that you consult with an attorney knowledgeable in any potentially applicable federal and/or state laws regarding the specific intended use of this form.
|Last Updated||February 8, 2023|
Certain covered employers may be required to notify employees of their 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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|NHF10022.1 Proof of Mailing COBRA Rights.pdf|
|NHF10021.2 Initial Notice of COBRA Rights.pdf|
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