Letters on Company Letterhead
Acknowledgement
/ Election of COBRA / Continuation Right
This 2 page form is for the benefits administrator to send to an employee who
has left the company or to the family of an employee who has passed away for
them to elect COBRA / Continuation. Please complete the first page, photocopy
for your files and send the 2 page form to the employee or family of the employee.
The employee or family members have 60 days to enroll in COBRA / Continuation.
Act
as Benefits Administrator
Please re-type this letter on company letterhead authorizing a person
that is not listed on your payroll (your accountant, the owners husband/wife
or adult child, business partner, etc.) to act as Benefits Administrator
for your company.
BOR
Aetna NJ
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Aetna NY
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Atlantis
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Cigna HealthCare
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Empire Blue Cross
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
General
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR GHI
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Guardian HealthNet
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR HIP
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Horizon HealthCare
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Oxford Health Plans
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
United HealthCare
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
Vytra Health Plans
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
BOR
WellChoice
This Broker of Record Letter will replace your current broker with
Inclusive Benefits. Please re-type on your company
letterhead and make sure you print the date, your policy number,
your name and signature. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately. We will call you once the BOR has been approved.
Change
on Plan Renewal
The Change on Plan Renewal must be typed on company letterhead and
must dictate the plan design and rate you are requesting to be change
to. You also must include your company name and policy number on
the letter.ÝOnce completed, please fax this to (212) 283-3104
and we will fax this to the appropriate department immediately.
Cobra
- NYS 18 months
This Cobra letter is to inform your former employee who has left
through voluntary or involuntary dismissal that they are entitled
to Cobra for 18 months. Please re-type on your company letterhead
and send it to your former employee. Please see the Health Insurance
Glossary for the complete reasons to elect 18 months of Cobra.
Cobra
- NYS 36 months
This Cobra letter is to inform the family of an employee who passed
away or a dependent student that has passed the dependent student
age status that they are entitled to Cobra for 36 months. Please
re-type on your company letterhead and send it to your former employee.
Please see the Health Insurance Glossary for the complete reasons
to elect 36 months of Cobra.
Company
Name, Address & Employer Identification Number Change
This letter is to be re-typed by the Benefits Administrator and is
to change your Company Name, Address and Employer Identification
Number with your current group insurance plan. Please re-type on
your company letterhead. Once completed, please fax this to (212) 283-3104 and we will fax this to the appropriate department
immediately.
Off
Anniversary Plan Downgrade
This letter is to be re-typed by the benefits administrator on company
letterhead in order to Downgrade your Plan Off Anniversary. Once
completed, please fax this to (212) 283-3104 and we will
fax this to the appropriate department immediately.
Rehire
Employee
This letter must be re-typed by the benefits administrator on company
letterhead in order to rehire an important employee back. Once completed,
please fax this to (212) 283-3104 and we will fax this to the appropriate
department immediately.
Rescind
Termination of Employee
This letter is to be re-typed by the benefits administrator on company
letterhead in order to rescind the termination of an employee. This
request can be made within 30 days of the date of termination for
reinstatement. Once completed, please fax this to (212) 283-3104
and we will fax this to the appropriate department immediately.
Rescind
Termination of Group
This letter is to be re-typed by the benefits administrator on company
letterhead in order to rescind the termination of your group plan.
This request can be made within 30 days of the date of termination
for reinstatement. Once completed, please fax this to (212) 283-3104
and we will fax this to the appropriate department immediately.
Sample
Student Verification
This letter must be received by the Bursars or Registration office
of the college your student is currently attending. The letter must
state that your student is maintaining full-time student status and
it must state the current semester. A new letter will be requested
at the beginning of each Spring, Summer and Fall semester. Once you
have obtained this letter, please fax this to (212) 283-3104
and we will fax this to the appropriate department immediately.
Segmentation
of Group
This letter is to be re-typed by the benefits administrator on company
letterhead in order to successfully segment the Owners/Mangement
from the Staff/Employees. Once completed, please fax this to (212)
283-3104 and we will fax this to the appropriate department immediately.
Termination
This letter is to be re-typed by the benefits administrator on company
letterhead in order to terminate your group plan. Once completed,
please fax this to (212) 283-3104 and we will fax this
to the appropriate department immediately.
| 
