COBRA Forms You May Not Be So Familiar With

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While many employers and HR professionals are familiar with the most common COBRA forms - the Initial COBRA Notice and the Qualified Event Notice - many are either unfamiliar or not aware of rules regarding “secondary” COBRA forms and notices.

Some of the secondary COBRA forms include:
  • Annual Enrollment Period Forms: This COBRA form allows the QB to change their coverage and is also used to notify the employee of changes to the employer’s coverage.
  • Termination Of COBRA Coverage: Although not required by COBRA, many employers send a Termination of COBRA Form to QBs when their COBRA period expires.
  • Notice Of Conversion Rights: COBRA requires that, at the end of their COBRA period, Qualified Beneficiaries be informed of any conversion-to-individual coverage rights they have under the plan.


  • While many employers engage outside service providers to assist them with COBRA forms and compliance, the primary responsibility for COBRA compliance rests with the employer. That is why having the proper COBRA forms at your fingertips could save you hours of time and hundreds of dollars.

    View Sample COBRA Forms
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    The HR Library has more helpful COBRA resources like these:

    Sample COBRA forms

    COBRA Initial Notice of Rights

    COBRA notices to Ex-Spouses

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