EXPLANATION OF USE FOR THE MODEL UNAVAILABILITY NOTICE
This memorandum is being provided to explain the use of the Model Unavailability 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”). Those
final rules require that if a plan administrator receives notice of a qualifying event from a participant who
is not eligible to receive COBRA, the administrator must provide notice to any such individual explaining
that he or she is not eligible for continuation coverage and explaining why he or she is not eligible for
continuation coverage.
The attached Model Unavailability Notice has been prepared by Blue Cross & Blue Shield of Mississippi
as a courtesy to our customers and should be used by you as the employer or by your Plan Administrator.
However, please understand that the attached Model Unavailability Notice is intended to serve only as a
guide to assist you in the development of your group’s Model Unavailability Notice. Please remember, if
your group is not subject to COBRA then you will not need to utilize this notice. Your Model
Unavailability 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 Unavailability Notice to be altered to include that information. This
Model Unavailability Notice must be sent to the individual who provided notice of a qualifying
event within 14 days of the receipt of the notice of qualifying event.
This notice must be provided regardless of the basis for the denial and regardless of whether the notice
involves a first or second qualifying event or a request for a disability extension. It is also recommended
that this Notice o