{
 "asOf": "2026-10-09",
 "noticeType": "election",
 "noticeDate": "2026-10-09",
 "qualifyingEvent": {
  "type": "termination",
  "date": "2026-09-30",
  "lossOfCoverageDate": "2026-09-30",
  "employerIsAdministrator": true
 },
 "noticeText": "IMPORTANT INFORMATION: COBRA CONTINUATION COVERAGE AND OTHER HEALTH COVERAGE ALTERNATIVES\n\nExample Manufacturing Group Health Plan\n\nNotice date: October 9, 2026\n\nYou are getting this notice because you recently gained the right to continue your health coverage under the Example Manufacturing Group Health Plan (the Plan) through COBRA continuation coverage. This notice explains your options and how to elect. Please read it carefully.\n\nPlan contact: Example Benefits Administration, COBRA Administrator, 100 Example Way, Suite 200, Anytown, ST 00000. Telephone: (555) 010-0100.\n\nWhy am I getting this notice?\nYour coverage under the Plan will end on September 30, 2026 because of the end of your employment. This is a qualifying event under COBRA. Federal law requires most group health plans to give employees and their families the chance to continue their health care coverage after a qualifying event.\n\nWho may elect?\nThe following qualified beneficiaries may elect COBRA continuation coverage: you (the covered employee), your spouse, and your dependent children who were covered under the Plan on the day before the qualifying event. Each qualified beneficiary has an independent right to elect continuation coverage. You or your spouse may elect on behalf of all other qualified beneficiaries, and a parent or legal guardian may elect on behalf of a minor child.\n\nWhat coverage is offered?\nCOBRA continuation coverage is the same coverage you had under the Plan on the day before the qualifying event. If you elect, coverage begins on October 1, 2026, the day after your Plan coverage ends, so there is no gap. More detail on the coverage is in the Plan's summary plan description (SPD).\n\nHow do I elect, and by when?\nTo elect, complete the enclosed election form and mail it to the COBRA Administrator at the address above. You have 60 days to elect. Your election must be postmarked no later than December 8, 2026. If you do not elect by that date, you lose your right to elect.\n\nWhat if I do not elect or I waive coverage?\nIf you do not elect COBRA continuation coverage, or you waive it, your coverage under the Plan will end on September 30, 2026. Not electing may affect your rights to special enrollment in another group health plan and to coverage through the Health Insurance Marketplace. If you waive coverage now, you may revoke the waiver at any time before the election deadline by sending a written revocation to the COBRA Administrator. Coverage then begins on the date the revocation is received.\n\nHow long does coverage last?\nBecause the qualifying event is the end of employment, COBRA continuation coverage lasts up to 18 months, through March 31, 2028. Coverage may end early if a premium is not paid on time, if the employer stops offering any group health plan, if a qualified beneficiary becomes covered under another group health plan after electing, or if a qualified beneficiary becomes entitled to Medicare after electing.\n\nCan coverage be extended?\nIf the Social Security Administration determines that a qualified beneficiary is disabled, every qualified beneficiary in the family may receive up to an additional 11 months, for a total of 29 months. A second qualifying event, such as the death of the employee, divorce, or a child losing dependent status, can extend coverage for a spouse and dependent children up to 36 months in total.\n\nYour duty to notify the Plan\nTo get the disability extension, you must notify the COBRA Administrator in writing within 60 days of the Social Security disability determination and before the end of the first 18 months of coverage. To get the second qualifying event extension, you must notify the COBRA Administrator in writing within 60 days of the second qualifying event. If you do not give these notices on time, you lose the extension. You must also notify the Plan within 30 days if the Social Security Administration later determines that the qualified beneficiary is no longer disabled.\n\nHow much does it cost?\nThe monthly premium is 102 percent of the cost of the coverage: $612.00 for employee only, $1,224.00 for employee plus spouse, and $1,836.00 for family coverage.\n\nWhen and how do I pay?\nYour first payment is due 45 days after the date you elect. It must cover every month from October 1, 2026 through the month you pay. After that, payments are due on the first day of each month, and you may pay monthly. There is a grace period of 30 days after the first day of each month. Send payments to the COBRA Administrator, 100 Example Way, Suite 200, Anytown, ST 00000. If a payment is late or not paid in full by the end of the grace period, your continuation coverage will end and cannot be restored.\n\nWhat about Medicare?\nIf you are eligible for Medicare, you should generally enroll when you first become eligible. If you do not enroll in Medicare and elect COBRA instead, you may have to pay a Part B late enrollment penalty and may have a gap in coverage. If you have both, Medicare generally pays first.\n\nKeep the Plan informed of address changes\nTo protect your rights, keep the COBRA Administrator informed of any change of address for you, your spouse and your dependents, and keep a copy of any notices you send.\n\nMore information\nThis notice does not fully describe continuation coverage or other rights under the Plan. More complete information is available in the Plan's summary plan description or from the COBRA Administrator at (555) 010-0100.\n"
}