Medical Reimbursement Letter

Sample Template Example of Medical Reimbursement Request Letter  Format to Insurance Company in Word / Doc / Pdf Free Download

LETTER TO HEALTH BENEFITS INSURER COMPANY REQUESTING REIMBURSEMENT FOR EXPENSES

[DATE, ex. Wednesday, June 11, 2014]

[NAME, COMPANY AND ADDRESS, ex.

John Smith

XYZ Inc.

1234 First Street

Suite 567

Anycity, Anystate  85245]

Dear [NAME, ex. John Smith],

I enclose a completed medical claim form together with receipts totaling $[AMOUNT OF RECEIPTS, ex. $233.29] in respect of [DESCRIBE NATURE OF AMOUNTS PAID, ex. minor surgery administered to our employee, [NAME OF EMPLOYEE].

Kindly provide us with a Check payable to the employee in the above amount.

Please address all correspondence to our address noted on our letter head and marked “Personal and Confidential”.

Sincerely,

[YOUR NAME, ex. Jill Jones]

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