Employee COBRA Detail

Fields on the Employee COBRA Detail

Employee Number. The employee for whom a COBRA notification needs to be made or whose former dependent-relative requires a COBRA notification.

Benefit Information

Benefit Code. The Benefit Code for this COBRA detail. Each COBRA-eligible benefit needs one Employee COBRA Detail record to be included on the notification and election form.
Vendor Name. The Vendor Name for COBRA coverage can be selected.
Effective Date and Termination Date. Enter or verify the Effective Date and Termination Date for the benefit, if not already populated.

COBRA Information

Monthly COBRA Cost. You may manually enter the Monthly COBRA Cost. The Monthly COBRA Cost field populates from the Benefit Code's COBRA Cost field.
Begin and End Date. Enter the Begin and End Date for the COBRA coverage according to the COBRA regulatory guidelines.
COBRA Declined checkbox, Declined Code, and Declined Date. If the employee has declined COBRA benefit continuation: select the COBRA Declined checkbox, select the Declined Code (from the selection list derived from the COBRA Declined Codes Table), and enter the Declined Date when the eligible individual officially declined COBRA coverage on the COBRA notification and election form.