COBRA Sample Letters with Explanations

COBRA communications are generated overnight, and there are a multitude of communications that Ameriflex sends to a participant. Some require action or acknowledgement and some do not. Here is a comprehensive list of COBRA communications your clients receive, and how they should handle them.
Written by Michele Lombardo
Updated 9 months ago

There are a significant number of COBRA communications sent out to your participant. Most of them only require your participant to review them, but there are a few that require immediate attention and client action. We have categorized the notices below so that you and your participants will know what to look out for.

Notices that REQUIRE client action:

  • Enrollment
  • Plan change
  • Plan delete
  • Termination
Note: In the instance that the client does not have carrier contact information on file, it is the clients responsibility to provide these notices to the carrier.

Notices that do NOT require action and can be disregarded:

  • Main Address Change to New Address Letter (QB/SPM)
  • New Broker Login Letter
  • New Client Division Login Letter
  • New Client Login Letter
  • New Member Login Letter

Notices that do NOT require action but SHOULD BE REVIEWED:

  • COBRA General Rights Notice - This is a notice the new plan member (NPM) receives when they are first added to the system. It reviews an NPM's basic COBRA rights, including a description of qualifying events, the type of coverage provided, and how long they can be covered.
  • 45 Day First Premium Month Paid Letter - Participant has paid First month of COBRA, However they have to paid their coverage to current. (I.E. Participant paid for April, but May and June is still due) 
  • 45 Day No Payment Letter - Elections without payment were made and the participant has 45 days to make a payment.
  • 45 Day Partial Payment Letter - when the participant submits their election form with a payment that does not cover at least one premium month. This letter details the payments the member must make to satisfy the initial premium payment requirement and avoid having their plan(s) canceled. 
  • COBRA Department of Labor General Rights Notice - This is a notice the new plan member (NPM) receives when they are first added to the system. It reviews an NPM's basic COBRA rights, including a description of qualifying events, the type of coverage provided, and how long they can be covered. This notice may also include a HIPAA Certificate.
  • COBRA Specific Rights Notice - A QB receives a COBRA Specific Rights Notice when they lose group health plan coverage because of a qualifying event such as termination or retirement, and they have at least one plan. It reviews how the QB can elect COBRA coverage, pay premiums, and terminate coverage; how long the coverage period lasts and under what circumstances the coverage period may be extended; and information about coverage for dependents. A QB may also receive this notice if they add or delete a plan before their First Day of COBRA. The Specific Rights notice can be manually re-queued and regenerated. This notice may include a HIPAA Certificate (QB and NPM) or State Letter Insert. The specific wording of the COBRA Specific Rights notice depends on the qualifying event type.
  • COBRA Department of Labor Specific Rights Notice - A QB receives a COBRA Specific Rights Notice when they lose group health plan coverage because of a qualifying event such as termination or retirement, and they have at least one plan. It reviews how the QB can elect COBRA coverage, pay premiums, and terminate coverage; how long the coverage period lasts and under what circumstances the coverage period may be extended; and information about coverage for dependents. A QB may also receive this notice if they add or delete a plan before their First Day of COBRA. The Specific Rights notice can be manually re-queued and regenerated. This notice may include a HIPAA Certificate (QB and NPM) or State Letter Insert. The specific wording of the COBRA Specific Rights notice depends on the qualifying event type.
  • COBRA Termination Letter - A QB receives a COBRA Termination letter when their status changes to Terminated (TE) on all plans, most typically because of non-payment of the premium. Loss of coverage applies to the member and all of his or her eligible qualified dependents. The termination letter includes basic plan information, the termination reason, and the termination date. This notice may also include a HIPAA Certificate.
  • Conversion Option Letter - A QB receives a Conversion Option letter 180 days before their last day of COBRA coverage, if they are enrolled in a plan with individual policy conversion rights. It provides the member with contact information for their Carrier's Customer Service department so they can request individual coverage if they want to continue their plan as an individual policy.
  • Disability Extension Confirmation Letter - A QB receives a Disability Extension Confirmation letter when they become disabled within the first 60 days of their COBRA coverage. The TPA must receive the Social Security Administration's disability determination letter within 60 days of notification of the QB's disability. If these conditions are met, the QB is eligible for up to an additional 11 months of COBRA coverage. Extended coverage also applies to their spouse and dependent children. The Disability Extension Confirmation letter also informs the QB of a possible premium increase during the 11-month extension period and what to do if they are no longer disabled.
  • Disability Extension Denial Letter - A QB receives a Disability Extension Denial if they become disabled during their COBRA coverage period, but the determination is not made during the first 60 days of their coverage. In order to qualify for an additional 11 months of coverage, the date of the disability must be during the first 60 days of COBRA and the TPA must receive a determination from the Social Security Administration within 60 days of being notified of the QB's disability. If a QB's disability extension is denied, their COBRA coverage expires at the end of their original maximum continuation period.
  • Election Form (QB) - A QB receives an Election Form to select the plans they want to continue (or waive) under COBRA. The member must return the form to the TPA before the last day to elect. They can elect coverage for themselves and for any of their eligible dependents. It includes plan information, such as the coverage level and period, premium amounts, and the last day they can elect coverage.
  • Election Form (SPM) - A SPM receives an Election Form to select the plans they want to continue (or waive) under COBRA. The member must return the form to the TPA before the last day to elect. They can elect coverage for themselves and for any of their eligible dependents. It includes plan information, such as the coverage level and period, premium amounts, and the last day they can elect coverage.
  • Enrollment Confirmation Letter (QB) - A QB receives an Enrollment Confirmation letter when their status changes to Enrolled (E). This occurs after the TPA processes their election form for one or more plans, and the member pays the full initial COBRA premium. This letter provides details about the member's plans, coverage level and length of coverage (including dates), payment grace period, how long they are currently paid through, and their projected premiums.
  • Enrollment Confirmation Letter (SPM) - An SPM receives an Enrollment Confirmation letter when their status changes to Enrolled (E). This occurs after the TPA processes their election form for one or more plans, and the member pays the full initial premium. This letter provides details about the member's plans, coverage level and length of coverage (including dates), payment grace period, how long they are currently paid through, and their projected premiums.
  • HIPAA Certificate (QB and NPM) - A QB or NPM may receive a HIPAA Certificate as an attachment to several other letters. When attached to the COBRA Specific Rights Notice or COBRA General Rights Notice, the HIPAA Certificate acts as a Certificate of Credible Coverage. It outlines the member’s rights under HIPAA and includes information about the member and their plan, as well as their hire/enrollment date and last day of coverage (if applicable). It also indicates the dependents who were covered under the plan, their relationship to the member, and when their benefits began and ended.
  • HIPAA Certificate (SPM) - A SPM receives a HIPAA Certificate as an attachment to their termination letter. It outlines the member’s rights under HIPAA and includes information about the member and their plan, as well as their hire/enrollment date and last day of coverage (if applicable). It also indicates the dependents who were covered under the plan, their relationship to the member, and when their benefits began and ended.
  • Initial Period First Premium Month Paid Letter - An SPM receives an Initial First Premium Paid letter when they submit their election form with a payment that covers only one month of their premium but they owe for multiple months. This letter details the payments the member must make to satisfy the initial premium payment requirement and avoid having their plan(s) canceled.
  • Initial Period No Payment Letter - An SPM receives an Initial No Payment letter when they submit their election form but do not send any payment with the form. This letter details the payments the member must make to satisfy the initial premium payment requirement and avoid having their plan(s) canceled.
  • Initial Period Partial Payment Letter - An SPM receives an Initial Partial Payment letter when they submit their election form with a payment that does not cover at least one premium month. This letter details the payments the member must make to satisfy the initial premium payment requirement and avoid having their plan(s) canceled.
  • Insignificant Payment Letter - A QB receives an Insignificant Payment letter when their premium payment is short of a full payment by an "insignificant amount." The member must make a full payment within their normal grace period or 30 days from the date of the letter, whichever is later, or their coverage will be canceled. It informs the member how much they still owe and the date by which they must submit their payment.
  • Late Payment Reminder Letter (QB) - A QB receives a Late Payment Reminder letter when the TPA has not received the member’s premium payment by the due date. It notifies the member of the last accepted postmark date and their premium amount due, as well as the address where they should send their payment. If a TPA chooses to send a Second Late Payment Reminder letter, the member receives a second letter if their payment still has not been received by the specified date. This letter is identical to the first late payment reminder, but includes additional text that it is the second reminder.
  • Late Payment Reminder Letter (SPM) - A SPM receives a Late Payment Reminder letter when the TPA has not received the member’s premium payment by the due date. It notifies the member of the last accepted postmark date and their premium amount due, as well as the address where they should send their payment. If a TPA chooses to send a Second Late Payment Reminder letter, the member receives a second letter if their payment still has not been received by the specified date. This letter is identical to the first late payment reminder, but includes additional text that it is the second reminder.
  • Main Address Change to New Address Letter (QB) - A QB receives a Main Address Change to New Address letter when their address on file changes. This letter is sent to the member's new (current) address to confirm the address change; if the member's address was mistakenly or fraudulently changed, they can contact customer service to correct the mistake.
  • Main Address Change to New Address Letter (SPM) - A SPM receives a Main Address Change to New Address letter when their address on file changes. This letter is sent to the member's new (current) address to confirm the address change; if the member's address was mistakenly or fraudulently changed, they can contact customer service to correct the mistake.
  • Main Address Change to Old Address Letter (QB) - A QB receives a Main Address Change to Old Address letter when their address on file changes. This letter is sent to the member's old (previous) address for privacy and protection reasons; if the member's address was mistakenly or fraudulently changed, they can contact customer service to correct the mistake.
  • Main Address Change to Old Address Letter (SPM) - A SPM receives a Main Address Change to Old Address letter when their address on file changes. This letter is sent to the member's old (previous) address for privacy and protection reasons; if the member's address was mistakenly or fraudulently changed, they can contact customer service to correct the mistake. 
  • Medicare Letter (QB) - A QB receives a Medicare letter when they reach age 65 and become eligible for Medicare benefits. Once a QB begins coverage under Medicare, they are no longer eligible for COBRA benefits. The Medicare letter includes contact information so the QB can send confirmation of Medicare benefits to the carrier's customer service department.
  • Medicare Letter (SPM) - A SPM receives a Medicare letter when they reach age 65 and become eligible for Medicare benefits. Once a QB begins coverage under Medicare, they are no longer eligible for COBRA benefits. The Medicare letter includes contact information so the QB can send confirmation of Medicare benefits to the carrier's customer service department.
  • New Broker Login Letter - A contact at a Broker receives the New Broker Login letter after you add them to the a Broker record and click the Create Login link to begin the process of registering the contact. This letter contains the information they need to access the Broker Portal, including their unique registration identification number, the portal's web address, and logon instructions.
  • New Client Division Login Letter - A contact at a Broker receives the New Broker Login letter after you add them to the a Broker record and click the Create Login link to begin the process of registering the contact. This letter contains the information they need to access the Broker Portal, including their unique registration identification number, the portal's web address, and logon instructions.
  • New Client Login Letter - A contact at a Client receives the New Client Login letter after you add them to the a Client record and click the Create Login link to begin the process of registering the contact. This letter contains the information they need to access the Client Portal, including their unique registration identification number, the portal's web address, and logon instructions
  • New Member Login Letter - A QB receives a New Member Login letter after you create a system record for them. The letter is automatically sent to the letter queue when the record is saved. It is processed out of the letter queue during the next nightly processing procedure. This letter contains the information the member needs to access the Member Portal, including their unique registration identification number, the portal's web address, and logon instructions. It also provides the member with an overview of the resources they can access through the portal, such as payment information, coverage information, and copies of communications.
  • Partial Payment Letter (QB) - A QB receives a Partial Payment letter when they submit a payment (or a reallocation occurs) that does not fully satisfy their current premium due. It reminds the member of their remaining balance. Their remaining premium payment must be postmarked before the end of the grace period to avoid termination.
  • Partial Payment Letter (SPM) - A SPM receives a Partial Payment letter when they submit a payment (or a reallocation occurs) that does not fully satisfy their current premium due. It reminds the member of their remaining balance. Their remaining premium payment must be postmarked before the end of the grace period to avoid termination.
  • Plan Change Letter (QB) - A QB receives a Plan Change letter when something causes a change to their plan. It details the change that occurred, and outlines how the change affects the member’s coverage levels and premiums. It also lists up to 12 months of expected premiums, subsidies, and due dates.
  • Plan Change Letter (SPM) - A SPMreceives a Plan Change letter when something causes a change to their plan. It details the change that occurred, and outlines how the change affects the member’s coverage levels and premiums. It also lists up to 12 months of expected premiums, subsidies, and due dates.
  • Premium Coupon Book (QB) - A member can receive either a Premium Coupon Book or a Premium Notice to summarize their upcoming payments and remind them of the due dates. The premium coupon book contains multiple payment summaries per page (e.g., Jan, Feb, and Mar) which are designed to be cut off and returned with the payment. Each coupon is printed with the premium due date, amount due, customer information, and payment address. The system tracks when the member receives coupons and automatically generates the next book when necessary. The premium notice is a one page, letter-style notice that contains the payment summary for only one month. The notice also contains the premium due date, amount due, customer information, and payment address. There is a detachable portion of notice that is returned with the payment.
  • Premium Coupon Book (SPM) - A member can receive either a Premium Coupon Book or a Premium Notice to summarize their upcoming payments and remind them of the due dates. The premium coupon book contains multiple payment summaries per page (e.g., Jan, Feb, and Mar) which are designed to be cut off and returned with the payment. Each coupon is printed with the premium due date, amount due, customer information, and payment address. The system tracks when the member receives coupons and automatically generates the next book when necessary. The premium notice is a one page, letter-style notice that contains the payment summary for only one month. The notice also contains the premium due date, amount due, customer information, and payment address. There is a detachable portion of notice that is returned with the payment.
  • Premium Notice (QB) - A member can receive either a Premium Coupon Book or a Premium Notice to summarize their upcoming payments and remind them of the due dates. The premium coupon book contains multiple payment summaries per page (e.g., Jan, Feb, and Mar) which are designed to be cut off and returned with the payment. Each coupon is printed with the premium due date, amount due, customer information, and payment address. The system tracks when the member receives coupons and automatically generates the next book when necessary. The premium notice is a one page, letter-style notice that contains the payment summary for only one month. The notice also contains the premium due date, amount due, customer information, and payment address. There is a detachable portion of notice that is returned with the payment.
  • Premium Notice (SPM) - A member can receive either a Premium Coupon Book or a Premium Notice to summarize their upcoming payments and remind them of the due dates. The premium coupon book contains multiple payment summaries per page (e.g., Jan, Feb, and Mar) which are designed to be cut off and returned with the payment. Each coupon is printed with the premium due date, amount due, customer information, and payment address. The system tracks when the member receives coupons and automatically generates the next book when necessary. The premium notice is a one page, letter-style notice that contains the payment summary for only one month. The notice also contains the premium due date, amount due, customer information, and payment address. There is a detachable portion of notice that is returned with the payment.
  • Rate Renewal Letter - A member can receive either a Premium Coupon Book or a Premium Notice to summarize their upcoming payments and remind them of the due dates. The premium coupon book contains multiple payment summaries per page (e.g., Jan, Feb, and Mar) which are designed to be cut off and returned with the payment. Each coupon is printed with the premium due date, amount due, customer information, and payment address. The system tracks when the member receives coupons and automatically generates the next book when necessary. The premium notice is a one page, letter-style notice that contains the payment summary for only one month. The notice also contains the premium due date, amount due, customer information, and payment address. There is a detachable portion of notice that is returned with the payment.
  • Reinstatement Letter (QB) - A QB receives a Reinstatement letter when a timely payment or a reallocation restarts their terminated COBRA continuation coverage. It includes the member's paid through date and the date their next premium is due, as well as next premium owed.
  • Reinstatement Letter (SPM) - An SPM receives a Reinstatement letter when a timely payment or a reallocation restarts their terminated coverage. It includes the member's paid through date and the date their next premium is due, as well as next premium owed.
  • SPM Welcome Letter - An SPM receives a SPM Welcome letter after you create a system record for them. The letter is automatically sent to the letter queue when the record is saved. It is processed out of the letter queue during the next nightly processing procedure. This letter contains the information the member needs to access the Member Portal, including their unique registration identification number, the portal's web address, and logon instructions. It also provides the member with an overview of the resources they can access through the portal, such as payment information, coverage information, and copies of communications.
  • Subsidy Letter (QB) - A QB receives a Subsidy letter when subsidy schedule is entered for the member. It provides details about the type of subsidy available to the member and their projected plan premiums, with their subsidy amount factored into the total amount due.
  • Subsidy Letter (SPM) - An SPM receives a Subsidy letter when subsidy schedule is entered for the member. It provides details about the type of subsidy available to the member and their projected plan premiums, with their subsidy amount factored into the total amount due.
  • Takeover Letter - A legacy QB receives a Takeover letter when the TPA associated with their plan changes. It informs the member that payment address has changed and that they should send all future payments to the new address stated in the letter. It also provides a summary of the member's plan information, coverage level, coverage dates, projected premiums, and payment due dates.
  • Termination Letter (SPM) - An SPM receives a Termination letter when their status changes to Terminated (T) on all plans, most typically because of non-payment of the premium. Loss of coverage applies to the member and all of his or her eligible qualified dependents. The termination letter includes basic plan information, the termination reason, and the termination date. This notice may also include a HIPAA Certificate.
  • Voided Payment Letter (QB) - A QB receives a Voided Payment letter when the TPA voids their payment. It provides details about the voided payment, including the amount of the payment and the reason why the payment was nullified. It also informs the member of the date through which their account is paid, when their next premium is due, and the amount of their current outstanding premium. If the member fails to pay their premium due in a timely manner, their coverage will be canceled.
  • Voided Payment Letter (SPM) - An SPM receives a Voided Payment letter when the TPA voids their payment. It provides details about the voided payment, including the amount of the payment and the reason why the payment was nullified. It also informs the member of the date through which their account is paid, when their next premium is due, and the amount of their current outstanding premium. If the member fails to pay their premium due in a timely manner, their coverage will be canceled.


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