Montana Acknowledgment of Receipt of COBRA Notice

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State:
Multi-State
Control #:
US-502EM
Format:
Word
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Description

This Employment & Human Resources form covers the needs of employers of all sizes.

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FAQ

DOL ERISA Penalties An employer is liable up to an additional $110 per day per participant if they fail to provide initial COBRA notices. ERISA can also hold any fiduciary personally liable for non-compliance.

COBRA is automatically available to you if you stop working at a qualified employer that provided group health insurance, but your participation in the program is not automatic. You must complete an enrollment form within the specified period of time and pay your first insurance premium.

In addition, employers can provide COBRA notices electronically (via email, text message, or through a website) during the Outbreak Period, if they reasonably believe that plan participants and beneficiaries have access to these electronic mediums.

Initial COBRA notices must generally be provided within 14 days of the employer notifying the third-party administrator (TPA) of a qualifying event.

With all paperwork properly submitted, your COBRA coverage should begin on the first day of your qualifying event (for example, the first day you are no longer with your employer), ensuring no gaps in your coverage.

The COBRA Rights Notification Letter Template contains a model form of the letter that all employees must receive either from their employer or from the benefit plan administrator of their benefit plans.

Are there penalties for failing to provide a COBRA notice? Yes, and the penalties can be substantial. Under the Employment Retirement Income Security Act of 1974 (ERISA), a penalty of up to $110 per day may be imposed for failing to provide a COBRA notice.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) permits employees and their dependents to extend health coverage under an employer's group health plan when coverage would otherwise be lost due to termination of employment or other qualifying events. Under COBRA, employees must receive specific notices

The general notice describes general COBRA rights and employee obligations. This notice must be provided to each covered employee and each covered spouse of an employee who becomes covered under the plan. The notice must be provided within the first 90 days of coverage under the group health plan.

If You Do Not Receive Your COBRA PaperworkReach out to the Human Resources Department and ask for the COBRA Administrator. They may use a third-party administrator to handle your enrollment. If the employer still does not comply you can call the Department of Labor at 1-866-487-2365.

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Montana Acknowledgment of Receipt of COBRA Notice