LETTER ADVISING EMPLOYEE THEY HAVE EXHAUSTED …

1 Date EMPLOYEE Name Address, City, State Zip Dear EMPLOYEE Name: I hope this LETTER finds you recuperating and getting your strength back [tweak language as appropriate for the EMPLOYEE 's or family member s situation]. Regrettably, I am writing to inform you that you have EXHAUSTED your 12 weeks of leave under the Family and Medical Leave Act (FMLA). Your accrued vacation and sick leave are also EXHAUSTED and you are currently in an unpaid status. Accordingly, your employment with ABC Co. will be terminated effective XX/XX/XXXX. Your enrollment in any of ABC Co. s medical, dental and vision plans will also terminate at that time. Information regarding your rights under COBRA will be sent to you under separate cover from COBRA Administrator Name, our COBRA administrator. ABC Co.

2 Will continue your coverage in any of our life and disability plans for a period of 6 months (through XX/XX/XXXX). You also have the right to sign up for health coverage through the Marketplace ( ObamaCare ). For more information, go to NOTE: If you enroll in COBRA, you will not qualify for a Special Enrollment Period with the Marketplace. If you enroll in COBRA and decide you want to sign up for health coverage through the Marketplace, you will have to wait until the fall of 2016 to sign up for coverage effective January 1, 2017. You may contact Life and Disability Carrier Name directly regarding the status of any disability claims, or to inquire about life coverage portability or conversion. Important Contacts: COBRA Administrator Name (COBRA administrator): 1-800-123-4567 (Marketplace): or 1-800-318-2596 Life and Disability Carrier Name (Disability claim inquiries, life insurance): 1-800-123-4567 Fred, you can reach me at 1-248-123-4567 should you have any questions that I may assist with.

3 Sincerely, Name Title