COBRA Notice Opt-Out Request - Admin America

Home COBRA Notice Opt-Out Request

Step 1 of 3

Submit an Opt-Out Request by Completing the Below Questions
By completing this form, I am instructing Admin America to not send the notices required by ARPA to the Qualified Beneficiaries of the designated employer.
Employer Name*
Authorized Representative's Name*
First Last
Authorized Representative's Email*
The details of your submission will be sent to the email address provided below.
Additional Email(s) (optional)
The details of your submission will be sent to the email address(es) provided below.

To send to multiple email addresses, separate the email addresses with a comma.

Save and Continue Later

COBRA Notice Opt-Out
Check the box below to Opt-Out of the AEI COBRA Notices
Opt-Out

Save and Continue Later

Opt-Out Agreement
By entering your name below you are hereby signing this document and agreeing that you are an authorized representative that has been entrusted to submit this opt-out request.

Signature*

Date*
MM slash DD slash YYYY

Save and Continue Later

6130
Δ

We provide expert welfare benefit plan advice to both brokers and businesses. With 30 years of experience we’ll ensure that you’re always getting the best guidance from the most professional company offering both administration and compliance.

Explore

Home

About Us

LOGIN

Services

Resources

Contact Us

Payment Center

Open Enrollment Login

FSA

HRA

COBRA

HSA

POP

Form 5500

ACA Reporting

ERISA Wrap

Download Our Mobile APP

Download iOS APP → Download Android APP →

SSL Certificate

BBB Accredited

Facebook

Twitter

LinkedIn

Website created by Codesmith Dev

Legal

Privacy Policy

© 2005 - 2023 Admin America

Top

Manage Cookie Consent

To provide the best experiences, we use technologies like cookies to store and/or access device information. Consenting to these technologies will allow us to process data such as browsing behavior or unique IDs on this site. Not consenting or withdrawing consent, may adversely affect certain features and functions.

Functional Functional Always active

The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.

Preferences Preferences

The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.

Statistics Statistics

The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.

Marketing Marketing

The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

Manage options Manage services Manage {vendor_count} vendors Read more about these purposes

View preferences

{title} {title} {title}