This template contains a COBRA election notice and election form to furnish to COBRA qualified beneficiaries to elect continuation of coverage under a group health plan after a qualifying event has occurred resulting in a loss of coverage. This template includes practical guidance, drafting notes, and optional clauses. Group health plans are required to provide election notices to qualified beneficiaries within 14 days after the plan administrator becomes aware of a COBRA qualifying event. This template is derived from the model election form notice published by the Department of Labor (DOL), as updated on May 1, 2020. The DOL model notice in its original form is available (along with a Spanish language version) at the DOL website. For a general practice note on COBRA, see COBRA Compliance and Enforcement. For a full listing of key content covering departing employees, see Departing Employees Resource Kit. For more information on notice requirements under COBRA, see COBRA Employer's ...