COBRA Qualifying Event Information Worksheet 2025

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Generous Time to Enroll You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended.
A loss of coverage caused by an event not listed as a triggering event will not result in a right to continuation coverage under COBRA. This includes events such as a change in plan eligibility rules, failure to pay plan premiums, or an employees decision to voluntarily drop coverage.
COBRA applies to most private sector businesses with 20 or more employees. It requires an employers group health insurance plan to continue after qualifying life events. These include: Termination or a reduction of a covered employees hours.
The following are qualifying events: the death of the covered employee; a covered employees termination of employment or reduction of the hours of employment; the covered employee becoming entitled to Medicare; divorce or legal separation from the covered employee; or a dependent child ceasing to be a dependent under
COBRA Qualifying Event Notice The employer must notify the plan if the qualifying event is: Termination or reduction in hours of employment of the covered employee, Death of the covered employee, Covered employee becoming entitled to Medicare, or Employer bankruptcy.