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Title Document Type HR Topics States Description
Form 12-16. Form for Reporting Breaches to HHS Form Health Care, Policies And Liability, Privacy HIPAA’s 2009 breach notification rules require covered entities to report breaches of unsecured protected health information to the affected individuals and to the U. S. Department of Health and Human Services (HHS).
Forms 11-47 through Forms 11-49. Revised Notices on COBRA Subsidy Extension Form Continuation Coverage, Group Health Insurance, Health Care As required by a new law that extended the COBRA premium subsidy program, model notices explaining an individual's right to the subsidy have been issued by the U. S. Department of Labor (DOL). .
Form 11-49. Updated COBRA Model Alternative Notice Form Continuation Coverage, Group Health Insurance Insurance issuers that provide group health insurance coverage must send the updated Alternative Notice to persons who became eligible for continuation coverage under a State law. Continuation coverage requirements vary among States and issuers should modify this model notice as necessary to conform it to the applicable State law.
Form 11-48. Model COBRA Premium Assistance Extension Notice Form Continuation Coverage, Group Health Insurance, Health Care Plan administrators must provide notice to certain individuals who have already been provided a COBRA election notice that did not include information regarding ARRA, as amended. This model Premium Assistance Extension Notice includes information about the changes made to the premium reduction provisions of ARRA by the 2010 DOD Act.
Form 11-47. Updated Model COBRA Continuation Coverage Election Notice Form Continuation Coverage, Health Care Plans subject to the Federal COBRA provisions must provide the updated General Notice to all qualified beneficiaries (not just covered employees) who experienced a qualifying event at any time from September 1, 2008 through February 28, 2010, regardless of the type of qualifying event, and who have not yet been provided an election notice.
Form 11-46. COBRA Premium Reduction Special Election Period Notice Form Continuation Coverage, Health Care Plans subject to the federal COBRA provisions must send this notice by April 18, 2009, to any assistance-eligible individual (or any individual who would be an assistance-eligible individual if a COBRA election were in effect) who: 1)      had a qualifying event at any time from Sept.
Form 11-45. COBRA Model Alternative Premium Subsidy Notice Form Continuation Coverage, Health Care Insurers that provide group health coverage must send the alternative notice to persons who became eligible for state-law continuation coverage. Insurers should modify the model notice as necessary to conform it to the applicable state law.
Form 11-44. Summary of COBRA Coverage Premium Reduction Provisions Form Continuation Coverage, Health Care The U. S. Department of Labor issued this form to provide summary information of the continuation coverage premium reduction provisions under the American Recovery and Reinvestment Act (ARRA), and intends that it be given to recipients of either the full or abbreviated general ARRA notices (Forms 11-42 and 11-43).
Form 11-43. COBRA Premium Subsidy "Abbreviated" General Notice Form Continuation Coverage, Health Care This notice includes the same information as the full version on the availability of the premium reduction and other rights under the American Recovery and Reinvestment Act, but does not include the COBRA election information.
Form 11-42. COBRA Premium Subsidy "Full" General Notice Form Continuation Coverage, Health Care Plans subject to the federal COBRA provisions must send the general notice to all qualified beneficiaries, not just covered employees, who experienced a qualifying event at any time from Sept. 1, 2008, through Dec.