EXPLANATION OF USE FOR THE MODEL GENERAL NOTICE
This memorandum is being provided to explain the use of the Model General Notice which is attached
hereto. By way of explanation, on May 26, 2004 the United States Department of Labor issued final rules
specifying the required content and timing of notices required by the health care continuation coverage
provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”).
The attached Model General Notice was a part of those final rules and should be used by you as the
employer or by your Plan Administrator. As a courtesy to our customers, we are providing this Model
General Notice as a guide for developing your group’s Model General Notice. Please remember, if your
group is not subject to COBRA then you will not need to utilize this notice. Your Model General
Notice should include the name of the plan and the name, address and telephone number of the party
responsible under the plan for administering COBRA benefits, in that connection, it will be necessary for
the provided Model General Notice to be altered to include that information. This Model General Notice
must be sent to an employee and the employee’s spouse within 90 days of the date on which any
such individual’s coverage commences under the plan.
As stated above, this notice must be provided to the employee and the employee’s spouse, however, a
separate Model General Notice is not required for dependant children residing with an employee or with
the employee’s spouse.
DISCLAIMER - Nothing contained, expressed, or implied in this Explanation of Use for the Model General Notice
or the Model General Notice attached hereto is intended as, nor shall be construed or understood as, legal advice,
guidance, or interpretation. No attorney-client relationship is established between Blue Cross & Blue Shield of
Mississippi and you by reason of your use of this Explanation of Use for the Model General Notice or the Model
General Notice attach