COBRA Underpayment of Premiums Notice

Editor's Note: In response to the COVID-19 pandemic, the U.S. Department of Labor (DOL) released a new final rule that temporarily extended the period in which eligible employees can elect COBRA health insurance coverage, and the deadline for them to begin making COBRA premium payments. In late January 2023, the Biden administration announced that the COVID-19 public health emergency and national emergency will end May 11, 2023. For information on how this impacts the extension periods for COBRA see New Guidance Helps Employers Navigate End of the COVID-19 Emergency Orders.

[Date]

Dear [Name]:

Thank you for your check in the amount of $[amount] submitted for your COBRA premium payment for the month of [month, year] which was received by us on [date]. Unfortunately, the payment you submitted was insufficient to cover the cost of your premium for the month. As we advised you previously (see attached copy of our previous correspondence) your monthly COBRA premium is [amount].

If you wish to continue your COBRA coverage under this plan, we must receive payment in the amount of $[amount] within 30 days from the date of this notice which would be [date]. Please submit a separate check for this amount and enclose it with this letter indicating your choice below.

Sincerely,

[Name]

Plan Administrator

I have received notification of underpayment of my COBRA premium. In accordance with this notice I am responding that:

[] I wish to end my coverage under this plan effective with the last month for which full payment was submitted.

[] I wish to continue my coverage. A check for the underpaid amount specified above is attached.

Printed name: ___________________________________________________

Signature: _______________________________  Date:  _______________