Health Insurance Termination Letter

When terminating your health insurance with your issuing company, you can communicate your intention through this Health Insurance Termination Letter.

[Sender’s Name]

[City, State and Zip Code]

[Email Address]


[Insurance Company’s Name]

The Health and Life Insurance Department

[City, State and Zip Code]

[Mobile/Fax Number]

Re: Health Insurance Cancellation

To Whom It May Concern,

I am writing to inform you that I, [Sender’s Name] of health insurance policy number [#], have decided to terminate my policy. This termination will take effect from [Date] after the final premium payment.

The reason for my insurance termination is [Reason for Termination]. The decision has been arrived at after several consultations and evaluations. Please send a written confirmation of cancellation and removal of my information from your system upon receipt of this letter.

Please pay any surrender amounts to my account, [Account Nummber]. Please complete this request as soon as possible.


[Sender’s Signature]

[Sender’s Name]

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