Page 36 - 2019 Sharks Benefits V6.1

BASIC pacific Administrators
P.O. Box 2170
Rocklin, CA 95677
PHONE: (888) 574-5448

Re: General COBRA Information for the SHARKS SPORTS & ENTERTAINMENT Health Plan

You are receiving this notice because you have recently become covered under one or more of the
group health plans sponsored by SAN JOSE SHARKS. This notice contains important information
about your right to COBRA continuation coverage, which is a temporary extension of coverage under
the Plan. COBRA continuation coverage was created by a federal law known as the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA). This information is intended to educate you
about your COBRA rights and obligations in the event that you or one of your dependents should lose
coverage under one or more of the plans. For simplicity, the remainder of this notice will refer to the
group health plans sponsored by SAN JOSE SHARKS collectively as the “Plan.”

While no action or response is required, both you and your spouse should read the information carefully
and keep it with your records. If you experience a loss of coverage in the future, please refer to this
overview for guidance about your rights and responsibilities. This notice gives only a summary of your
COBRA continuation coverage rights. For more information about your rights and obligations under the
Plan and under federal law, you should review the Plan’s Summary Plan Description or get a copy of
the Plan Document from the Plan Administrator.

Plan Administrator

SHARKS SPORTS & ENTERTAINMENT is the Plan Administrator. All notices and other
communications regarding the Plan and regarding COBRA must be directed to:

SHARKS SPORTS & ENTERTAINMENT
ATTENTION: HUMAN RESOURCES
525 WEST SANTA CLARA STREET
SAN JOSE, CA 95113

The Plan (as outlined below) offers no greater COBRA rights than what the COBRA statute
requires, and this Notice should be construed accordingly.

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