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