Enrollment Exception 4 Appeal Letter Free Download

Enrollment Exception 4

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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 #:
Claim #:

Dear Claims Review Department:

I am writing to you in regards to my plan’s benefit coverage. Due to unforeseen circumstances, I am requesting that you make an exception and allow me to modify my coverage outside the enrollment period window.

Option 1: Add if appropriate “I understand that there is a specified timeframe in which to enroll and I had every intention to comply with this requirement. However, due to {enter reason here}, I must request a change in my health plan’s prescription coverage to allow me appropriate coverage.

Option 2: Add if appropriate “As an employee of {name company} I realize that my employer is the owner of this health plan and can approve any exceptions. As a result of my {situation}, I am requesting that an exception be immediately granted.

Option 3: Add if appropriate “I am willing to pay any additional premiums due at the time this can be approved. I respectfully request that you take my situation into account and extend me an exception to this policy requirement. I am prepared to provide any necessary documentation to support this statement.”

Thank you for your time and consideration.


[Insured’s Name]