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Topic: Forms & Checklists |
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Provide this form to an employee or spouse within 90 days of the commencement of coverage or the first date at which the plan administrator is required to advise a qualified beneficiary of the right to elect coverage. Depending on your company’s plan, different options will apply. This form has boxes to check to ensure the form, upon completion, is an accurate description of COBRA coverage for your employees.
CalChamber Members
If you are a CalChamber member, you get this form -- and many more -- for free when you log in to HRCalifornia.com. Not a member and want this form for free? Learn more about the many benefits of membership.
Product Features
- Easy to use, fill-in-the-blank format
- Downloadable, RTF file for you to personalize
- Sample form
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