COBRA Notification and Election Letter

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System Forms > Reports

The COBRA Notification and Election report, FRM00007, produces the notification page and election form required for COBRA (Consolidated Omnibus Budget Reconciliation Act) compliance.

Records entered on the Employee COBRA Detail provide the plan elections listed on the election form. Monthly COBRA cost amounts are defined on the Benefit Costs Codes Table.

Print and complete the dates and mark the qualifying event or events on the notification before providing the notification and election form to eligible individuals. Record the responses on the Employee COBRA Detail.

Notification Page of the COBRA Notification and Election Report, FRM00007

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Election Page of the COBRA Notification and Election Report, FRM00007

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