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ARRA Subsidy Permanent Waiver Form

Assistance Eligible Individuals (AEI) are entitled to receive a 65% subsidy toward the payment of their COBRA premium for up to nine months or the duration of your COBRA coverage period, whichever is less. However, if the amount earned for the year is more than $125,000 (or $250,000 for married couples filing a joint federal income tax return), the AEI may have to repay all or part of the ARRA subsidy received through an increase in their income tax liability for the year.

If you think that your income may exceed the amounts above, you may wish to consider waiving your right to the subsidy. (For information on how it affects your own income tax situation, please consult your tax preparer. Discovery Benefits cannot provide tax advice.)

An AEI who wants to make a permanent election to waive the right to the subsidy may do so by completing and signing this form and sending the form to Discovery Benefits. No separate notification to a government agency is required.

Please note that by signing and submitting this permanent waiver, you are no longer eligible to receive the ARRA subsidy. This waiver is permanent and cannot be reversed, even if in 2009 or 2010, your modified adjusted gross income falls below the phase out thresholds in those years.

Form Type: Administrative
Categories: COBRA

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