Arizona Sample Notice of Continuation Coverage (Mini-COBRA)
Pursuant to ARS § 20-2330, a health benefits plan issued or renewed after December 31, 2018, must allow an enrollee and any qualified dependent to continue coverage after a qualifying event. The law requires a small employer (with an average of at least 1 but fewer than 20 employees) to notify an enrollee in writing of the right of the enrollee and any qualified dependents to continue coverage under the employer's health benefits plan upon an enrollee's qualifying event. Pursuant to Subsection C of the law, the Department has prepared a sample notice of coverage continuation form and is making the sample available on its website. A small employer that uses, properly completes, and timely issues the Department's form is presumed to satisfy notification requirements. On January 23, 2019, the Department uploaded a new version of the form.