Tracking COBRA Notification History

Access the Notification History Revisions form.

Participant Address

Enter the address number of the participant as defined in the Participant file table (F08901).

Original Qualifying Event

Enter a UDC 08/QE that indicates the initial event that qualified a participant for COBRA continuation coverage.

Original Event Date

Enter the date of the first (initial) event that qualified a participant for COBRA continuation coverage.

Subsequent Event

Enter a UDC 08/QE and description of the second event that qualifies the participant for COBRA continuation. There cannot be a second qualifying event unless an initial qualifying event has previously been entered for the participant.

Subsequent Event Date

Enter the date of the second qualifying event.

Qualifying Event Type

Enter a code that indicates whether a qualifying event is the original qualifying event (type O) or a subsequent qualifying event (type S).

Date Notice Created/Mailed

Enter the date that the election notice was mailed to the qualified beneficiary for the first qualifying event. The system automatically updates this date when you print any of the COBRA notices.

COBRA Notice Type

Enter a UDC 08U/CN that specifies the type of COBRA notice.

Notice Reason Code

Enter a code that specifies the reason for a COBRA termination notice or unavailability notice.

Related Employee

Enter the address book number of the employee for whom the original qualifying event was recorded.