The COBRA Initial Notice is the first of the two required

COBRA notices. In compliance with the provisions of COBRA requiring the employer to notify participants of their COBRA rights, the Personnel Office must provide the initial notice to employees within days of their enrollment in the MRA (i.e., when they first become covered under the MRA). An exception to the -day rule is when a qualifying event occurs before the initial notice is provided. In that case, an initial notice must be provided along with the election notice and election form. The COBRA Initial Notice is intended to provide a summary of their right to continue the MRA under COBRA if they experience a COBRA qualifying event. This is not a COBRA Election Notice. See Attachment C - COBRA Initial Notice, for a sample of an Initial COBRA Notification. The COBRA Initial Notice is also available on CalHR's web site. COBRA Election Notice and COBRA Election Form (CalHR ) Department Personnel Office - The Personnel Office should be aware of when an employee dies, termination from employment, or a reduction in hours that results in a loss of eligibility. At the time the qualifying event has occurred or when notified timely of a qualifying event, the departmental special lead Personnel Office must provide within days, a COBRA Election Notice (see Attachment D - COBRA Election Notice for a sample) and COBRA Election Form (CalHR ) (see Attachment E - COBRA Election Form (CalHR ) for a sample) to the employee. The COBRA Election Notice and Election Form is also available on CalHR's web site. A Reimbursement Account Enrollment Authorization (STD. R) should also be included with the notification. If the COBRA enrollment is elected, the Personnel Office should assist in the completion of the STD. R. After the completed STD. R, COBRA Election Form, and initial COBRA payment is returned, the department should retain copies for their records and submit the original package to CalHR. Employee Responsibility - The employee has the responsibility to inform the departmental Personnel Office when a qualifying event occurs. The Personnel Office must receive the notification within days after the date of the event or the date on which coverage is lost. If the notice to the Personnel Office is not received timely, then COBRA continuation coverage will not be offered. Employee Responsibility After Receiving COBRA Election Notice and COBRA Election Form If the employee wishes to elect COBRA, he/she must complete the COBRA Election Form and a STD. R for "COBRA Continuation" and send both documents to the Personnel Office within days from the date of the COBRA Election Notice. In addition, the enrollee must submit a personal check, money order, or cashier's check payable to CalHR in the amount of one monthly premium plus an additional % for administrative costs. For example, if a participant elects to continue a MRA at $ a month, the total monthly COBRA premium will be $ Subsequently, by the first of each month employees are responsible for submitting their COBRA payment to CalHR.