COBRA Notice
COBRA Election Notice / Continuation Coverage
Notice sent to qualifying beneficiaries explaining their right to continue employer-sponsored health coverage.
Fill out COBRA Notice free β no software, no printing, no account required.
About COBRA Notice β COBRA Election Notice / Continuation Coverage
The COBRA Election Notice is a federally required notice that group health plan administrators must send to qualifying beneficiaries within 14 days of receiving notification of a qualifying event β such as termination of employment, reduction of hours, divorce from the covered employee, or the covered employee becoming eligible for Medicare. The notice explains the individual's right to elect continuation coverage under COBRA (Consolidated Omnibus Budget Reconciliation Act), the coverage available, the election deadline (60 days), the premium cost (up to 102% of the full premium), and duration of coverage (typically 18β36 months depending on the qualifying event). Failure to provide timely notices exposes employers to significant penalties.
How to Fill Out COBRA Notice Online
- 1
Open COBRA Notice in the editor
Click "Fill Out COBRA Notice Online" above. The form loads instantly in your browser β no app, no software, no printing.
- 2
Complete every field
Type directly into each field of the official COBRA Notice form. Required fields are clearly labeled and the form auto-tabs for speed.
- 3
Sign electronically
Add your legally compliant e-signature directly on the form β no need to print, sign by hand, and re-scan.
- 4
Download your completed PDF
Export a clean, print-ready COBRA Notice PDF in seconds. File it, mail it, fax it, or save it to your device.
COBRA Notice is an official form published by DOL. Official source
Related Employment Forms
Employment Eligibility Verification
Mandatory federal form completed by both employer and employee to verify identity and employment authorization.
Employee's Withholding Certificate
Completed by new hires to instruct employers how much federal income tax to withhold from wages.
Log of Work-Related Injuries and Illnesses
Federal form used by covered employers to record and classify occupational injuries and illnesses during the calendar year.
Certification of Health Condition for FMLA Leave
Medical certification form used by employees requesting FMLA leave for their own serious health condition.
Certification of Family Member Health Condition (FMLA)
FMLA medical certification for employees requesting leave to care for a family member with a serious health condition.
EEOC Charge of Discrimination
Formal complaint filed with the Equal Employment Opportunity Commission alleging workplace discrimination.