• 401. General Information
• 402. Qualified Beneficiary
• 403. Initial General COBRA Notice
• 404. COBRA Qualifying Events
• 405. Retiree Benefit Plan Alternate Coverage
• 406. Leaves of Absence
• 407. Loss of Group Coverage in Anticipation of a Qualifying Event
• 408. COBRA Election Notice and Election Form
• 409. COBRA Qualifying Event Notification Responsibilities
• 410. Notice of Unavailability of Continuation Coverage
• 411. Election Period
• 412. Length of COBRA Coverage
• 413. COBRA Premiums
• 414. Gross Misconduct
• 415. Noncompliance Penalties and Fines
• 416. Open Enrollment Period
• 417. COBRA in Retirement
• 418. Loss of COBRA Continuation Coverage
• 419. Completion of COBRA Enrollment Forms
• 420. Dental/Vision COBRA Premiums
• 421. Insurance Plan Addresses

• View all Section 400

  Attachments

• Attachment A - Initial General COBRA Notice
• Attachment B - COBRA Election Notice
• Attachment C - COBRA Continuation Election Form
• Attachment D - Notice of Unavailability of Continuation Coverage
• Attachment E - Initial COBRA Notice Log
• Attachment F - COBRA Election Notice Log
• Attachment G - Monthly COBRA Status Report
• Attachment H - COBRA Calendar

• Table of Contents

   

410. Notice of Unavailability of Continuation Coverage

The Notice of Unavailability of Continuation Coverage Notice is the third of three required COBRA notices. In the event that the Personnel Office is notified of a qualifying event and determines that an individual is not entitled to elect continuation coverage, (i.e., 60-day notification period missed) the Personnel Office must provide a "Notice of Unavailability of Continuation Coverage", within 14 days to explain why the individual is not entitled to elect continuation coverage. Keep a copy in file of the actual notice sent. Refer to Attachment D for a sample of this notice.

Monthly COBRA Status Report

The Monthly COBRA Status Report is used to track the number of notices sent, types of qualifying events, and number of COBRA enrollments. Refer to Attachment G for a sample of the Monthly COBRA Status Report. You can access this report as a fill and print document on DPA's Web site at www.dpa.ca.gov (click on Benefits, then click on Dental or Vision Insurance, under Related Forms).