COBRA Template Request


Step 1 of 2

  • Submit a Template Request by Completing the Below Questions

  • Templates are only necessary for employers who began monthly COBRA administration services with Admin America after November 1, 2019.



  • The details of your submission will be sent to the email address provided below.


  • 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.