Notice of Divorce or Dependent Child No Longer Being Eligible


In the event of a divorce, a legal separation or a dependent child no longer satisfying eligibility requirements of a plan, you or a family member must formally advise your Employer of the Qualifying Event. Such notification must be provided in writing on a COBRA Employee Notice of Qualifying Event form. This form may be obtained from your Employer or by contacting Vita. The form must be sent to your Employer within 60 days of the Qualifying Event date or loss of coverage date, whichever is later. No exceptions can be made. If timely notice is not provided to your Employer, all Qualified Beneficiaries will lose their rights to elect COBRA. In addition, you must provide your Employer a copy of the divorce decree or legal separation document which confirms the final divorce or legal separation date. If your coverage is reduced or eliminated in anticipation of a divorce and later a divorce or legal separation occurs, your notice must provide satisfactory evidence to your Employer that you coverage was reduced or eliminated in anticipation of the divorce or legal separation.



When Notice Is NOT Required


In the event of a termination of employment, reduction of hours, or death, you need not take any action to request election materials. You should automatically receive a COBRA Election Notice at your home via the U.S. Postal Service from Vita. This COBRA Election Notice will outline coverage costs and options available to you and your dependents. If you wish to elect coverage, you must follow the guidelines detailed in the COBRA Election Notice.



Keep Plan Informed of Address Changes


To protect your rights, it is imperative that you keep Vita COBRA and your insurance company informed of any address changes. This includes notifying Vita COBRA of an alternate address for your spouse or children if your spouse or children do not reside with you. All address change requests must be submitted in writing to



Important Note on Notice Procedures


Warning: In certain circumstances, you are required to provide notice to Vita COBRA and/or your insurance plan. This includes in the event of a divorce, a legal separation, or a dependent child no longer being eligible under the plan. If that notice is late or if you do not follow the required notice procedures outlined, you and all related Qualified Beneficiaries will lose the right to elect COBRA (or will lose the right to an extension of COBRA, as applicable). Any notice that you provide must be in writing and must include the appropriate documentation (as applicable). Verbal notice, including notice by the telephone, in person, to a supervisor while you are still employed, or to your former employer or Vita COBRA after you are no longer employed, is not acceptable or sufficient notice. Keep a copy of all notices for your records.


The covered employee, a Qualified Beneficiary who lost coverage due to the Qualifying Event described in the notice, or a representative acting on behalf of the covered employee or the Qualified Beneficiary may provide notices. A notice provided by any of these individuals will satisfy any responsibility to provide notice of all Qualified Beneficiaries who lost coverage due to the Qualifying Event described in this notice.