New COBRA Application Packets Available

The newly revised COBRA Application Packet has been posted on the At Your Service website and is now available for use. You must re-issue or issue the updated COBRA ARRA Application Packet to everyone with a COBRA qualifying event in March and April, (e.g., involuntary separation, voluntary separation, divorce, overage child, leave of absence, etc.). The ARRA regulations require that the updated information must go to all who had a qualifying event, not just those who potentially might qualify for a premium subsidy.

The following chart provides clarification:

Qualifying Event Occurs DuringWho Is Responsible for Issuing COBRA ARRA InformationHow COBRA ARRA Information Will Be Delivered
9/1/2008 – 2/28/2009UCOPSpecial mailing from UCOP will be sent by 4/18/2009
3/1/2009 – 3/31/2009UCLA DepartmentMust re-issue ALL qualifying event application packets already issued using newly updated packet with ARRA information; must be mailed by 4/18/2009
4/1/2009 – 4/30/2009UCLA DepartmentMust issue updated COBRA ARRA Application Packet within required timeframe of qualifying event
5/1/2009 - ongoingCONEXISCONEXIS will mail COBRA Application Packets using CONEXIS’ updated ARRA notices and forms. (UC locations will just need to report the qualifying event—if necessary—on the CONEXIS website.)



Campus Human Resources, Benefits Services
Phone: (310) 794-0830 | Fax: (310) 794-0835