[Date]
[Former employee name]
[Address]
Dear [former employee name]:
According to our records, you have continued your [company name] group health coverage under COBRA since [date]. [Company name] health plan coverage and premium rates renew annually, the first of each calendar year and I am writing to inform you of a change in your COBRA premiums.
Due to increasing healthcare costs, our group health premiums are increasing effective [date] by [amount]. COBRA beneficiaries are charged the total cost of coverage for active employees plus a two percent administration fee. The new premium for your current election of [self-only, family, etc.] will be [amount] beginning [date].
Please be sure to submit your premiums promptly by the first of each month. If you have any questions about your COBRA continuation coverage, please contact me at [contact information] and I will be glad to help you.
Sincerely,
[Name]
[Title]
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