Consolidated Omnibus Budget Reconciliation Act of 1989 (COBRA)

To: ________________________________         Date: ___________________
      ________________________________
________________________________

Notification OF Continuation RIGHTS

Your Group Insurance has been terminated, as of __________________________. Subject to the provisions of the federal Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA), ,you may be able to continue your employer sponsored group health benefits, after coverage would normally terminate.

COBRA mandates that all employers, with 20, or more employees, that provide health benefit plans must allow, insured employees, spouses, and dependent children (participants) to elect to continue health coverage when the coverage ends due to certain specified "qualifying events". The participant shall be charged the entire premium due for this continued coverage.

COBRA defines a "qualifying event" as: 1) for the employee, if his! her coverage ends because of termination of employment, either voluntarily or involuntarily or if his/her hours are reduced as to make him! her ineligible for the health benefit plan your employer provides; 2) for the spouse or child (beneficiaries), if coverage ends due to employee's death, divorce, legal separation, or entitlement to Medicare, or if a child reaches the maximum age for a dependent child. If an employee's coverage ends, the law states that he/she can continue the coverage for his! her dependents.

The health benefits, which can be continued, are to be identical to the benefits provided under the health plans for other employees, and dependents. The continuation of benefits will be 18 months if the qualifying event is based on the employee, or 36 months in the event of a dependent qualifying event.

The continuation of benefits will end on the earliest of the following events: 1) the end of the period that the benefits can be continued; 2) the end of the period for which premium payment has been made; 3) the date the person becomes insured under another group plan or becomes entitled to Medicare; or 4) the date the employer's insurance policy with this insurance company terminates.

The enclosed Continuation of Coverage Election Form must be completed and returned to the employer with a postmark date no later than 60 days from the date of this notice. All applicable premiums must be paid to the employer within 45 days from the date coverage is elected. Thereafter, the premiums are due to the employer on the same basis as the employer normally remits premium.

The conversion privilege contained in our health benefit plan shall be available to those persons who elect to continue coverage. COBRA mandates that any person who is continuing coverage has the right to elect a conversion plan during the last 180 days of the continuation of coverage.

Please see that the attached Continuation of Coverage Election Form is signed, and dated in order that there are no delays in implementing this continuation of benefits.

Please complete, sign, and date the reverse side of the COBRA election form, and return to your previous employer for processing.

EMPLOYER:____________________