| | COBRA EMPLOYER FORMS |
| |
| | • | Takeover Listing & New Qualifying Event Template |
| | | If you do not currently use our website, you can use this spreadsheet to notify Planned Benefit Systems, Inc. when an employee or dependent experiences a COBRA Qualifying Event. |
| |
| | • | General (Initial) Notice Template |
| | | Use this form if you have contracted with Planned Benefit Systems, Inc. to send out your General (Initial) Notices to new hires or newly covered employees. |
| |
| | • | Web Access Request Form |
| | | Request user access to the COBRA Web in order to process COBRA Notifications and General Notices online as well as view Qualified Beneficiary information. |
| |
| |
