You can open the Loss Of Health Insurance Coverage Letter From Employer Template in multiple formats, including PDF, Word, and Google Docs.
Loss Of Health Insurance Coverage Letter From Employer Template Printable | Editable FormSample
Examples
[Employer’s Name]
[Employer’s Address]
[Employer’s Phone]
[Employer’s Email]
[Employee’s Name]
[Employee’s Address]
[Date]
Notice of Loss of Health Insurance Coverage
We regret to inform you that your health insurance coverage under our company plan will be terminated due to [reason for termination, e.g., employment status change, insufficient hours worked]. This notice serves to officially notify you of this change and to provide important information regarding your coverage.
Your health insurance coverage will be terminated effective [effective date]. As a result, you will no longer be able to access medical and healthcare benefits through our plan following this date.
You may be eligible for continued health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). If you wish to explore this option, please contact our HR department at [HR contact information] for further details and enrollment information.
Please be aware that you have certain rights under federal and state laws regarding health insurance coverage, which may include options for short-term health insurance plans, marketplace insurance, or state-specific programs. It is crucial that you review these options as soon as possible.
Upon loss of coverage, you are responsible for settling any outstanding medical claims or bills accrued prior to the termination date. Ensure you have all necessary documents for any claims you wish to file.
We understand that losing health insurance coverage can be challenging, and we encourage you to reach out with any questions or concerns regarding this notification or your available options. Our team is here to assist you during this transition.
[Signature of the Employer]
[Name of the Employer]
[Position of the Employer]
[Company Name]
[Company Address]
[Company Phone]
[Company Email]
[Employee’s Name]
[Employee’s Address]
[Date]
Termination of Health Coverage Notification
This letter serves as formal notification regarding the termination of your health insurance coverage as a result of [specific circumstances leading to termination]. We understand this may have significant implications for you and your family, and we aim to provide you with clarity on your options.
Your health insurance coverage will cease as of [termination date]. All benefits associated with our company policy will no longer be available after this date.
As per COBRA, you are entitled to continue your health benefits through our plan for a limited time. If you choose to pursue this option, please contact [HR representative’s name] at [HR contact number] for assistance with enrollment and costs.
This termination affects not only your coverage but also that of any dependents enrolled in your health plan. We suggest that you review your family’s health needs and reach out to potential alternate insurance providers.
If you have any claims or medical coverage issues still outstanding, please ensure they are addressed before the termination date. Our HR team is available to help you navigate this process if you require assistance.
We appreciate your contributions to [Company Name], and we are here to support you through this transition phase. Please do not hesitate to get in touch if you have any further questions or need clarification on your coverage status.
[Signature of the Employer]
[Name of the Employer]
[Position of the Employer]
Format
Please complete the form below to create the Loss Of Health Insurance Coverage Letter From Employer Template. All fields must be filled out to ensure a clear and complete letter. We provide examples to guide you through each step. Loss Of Health Insurance Coverage Letter From Employer Template 1. Employer Information 2. Employee Information 3. Coverage Details 4. Reason for Loss of Coverage 5. Alternative Coverage Options 6. Important Information 7. Acknowledgment of Receipt Please acknowledge the receipt of this letter by signing below: 8. Signatures
PDF
WORD
Google Docs
Loss Of Health Insurance Coverage Letter From Employer Template Printable | Editable FormPrintable
