Adams® COBRA Late Payment Notice, 1-Use Interactive Digital Legal Form
$6.95
Adams
1 form
DLF499-SL
Employers or plan administrators may use this letter as a notice of late payment to an employee or beneficiary receiving group health plan coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Available in increments of 1
- Letter provides notice of late payment for those electing continuation of coverage under COBRA
- Provides date by which coverage will be terminated without further payment
- Offers contact information for persons needing further assistance
- Attorney-reviewed form valid for general use in every state
- Click the secure link in your account to begin the interactive Q&A that creates your legal form
- Responses auto save as you work; return any time to complete your secure form at topslegalforms.com/docs
- Online Guidance Notes offer additional information on signing, filing, and executing your documents
- Download to save and print your customized PDF file
| Item # | DLF499-SL |
|---|---|
| Purchasing Quantity | 1 form |
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