Download "Enrollment Exception 3 Appeal Letter" Word Document
Appeal Letter Displayed for Your Convenience
Health Symphony Appeal Letter
For Enrollment Exception
Your name and address
Address of Claims review department
RE: Name of Insured:
Plan ID #:
Dear [Health Plan] Enrollment Department:
I am writing to you in regards to an error in my enrollment with the group health plan.
I understand that there is a specified timeframe in which to enroll, which my husband and I adhered to. However, the options selected were for insurance coverage for my spouse and I and I have been surprisingly been informed that I do not have coverage, only my spouse is insured. This is clearly a mistake.
Optional: The information entered during the benefit enrollment period was for my husband and I. There was an error in how the information was accepted. We should not be penalized for this error.
I respectfully request that you take this information into consideration and extend me an exception to this policy requirement.
Thank you for your time and consideration.