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To use this model election notice properly, the Plan Administrator must fill in the blanks with the appropriate plan information. The Department considers ... The name of the health insurance plan. Contact information for someone who can explain COBRA coverage in more detail. A description of the ...This report includes an overview of the information contained in the notice, including eligibility, the definition of involuntarily termination, ... A. Please note: Some Seamless Docs forms may require you to forward the document via email. Acknowledgment of Receipt · AFLAC Wellness Accident Plan. This handbook is not a contract or guarantee of employment. Georgia State University reserves the right to unilaterally modify, amend or terminate policies, ... Notice Regarding Disability: Notice that: (a) a Qualified Beneficiary entitled to receive COBRA Continuation. Coverage with a maximum duration of 18 months ... covered employees; terminated COBRA participantsThe notice must advise the participant of their rights to have the opportunity, ... Attorney-reviewed to ensure compliance with COBRA notice requirements and the American Rescue Plan Act (ARPA);; Printable, fill-in-the-blanks digital format for ... And/or in-house counsel to verify COBRA/Continuation status.of the need to reinstate/re-enroll Continuation participants following receipt of their. Your job title, compensation, other current benefits, the Term (defined in Schedule A) and additional details are more fully set forth in Schedule A.