Request Immediate Insurance Coverage For New Employee Template

For some employees exposed in hazardous job conditions, employers often opt to apply immediate insurance in order to cover them from potential safety issues. Our Request Immediate Insurance Coverage for New Employee template allows employers to send out an immediately useable request letter to Insurance providers for the instant activation of insurance coverage to a new employee. Forget the hassle of having to make a request letter from scratch and simply click on the download button to access our file. Keep your employee and your business safe by starting insurance coverage for hazard prone employees immediately. Act now by downloading the file.

Request Immediate Insurance Coverage for New Employee

[DATE]

Dear [RECIPIENT NAME],

Good Day!

I am writing on behalf of our new employee, who has been hired last [HIRING DATE]. 

As per our company policy and eligibility criteria of coverage of health benefits, you should render a total of at least [NUMBER] hours or [NUMBER 1] days a month from the first day of employment. The hours of work that is counted for the eligibility of the benefit plan shall include the actual hours of work rendered, and the hours for which the employee is paid while on vacation leave, sick leave or holidays.

However, we are waiving said waiting period for the eligibility of Mr. /Ms. [NAME], and hereby request for [HIS/HER] immediate insurance coverage, with a starting  [STARTING DATE] date on 

Provided below is the personal information of the new employee:

Full Name:

Age:

Status:

Religion:

If married:
Name of Spouse:

No. of Dependent/s:

Name of Dependent/s:

Address:

Social Security Number:

Beneficiary/Beneficiaries:

Below is the detailed portion of the employee for the insurance coverage:

Cost per Pay Period
Cost per Month
Supplemental Life Insurance
$[NUMBER 2]
$[NUMBER 3]
Dependent Life Insurance
$[NUMBER 4]
$[NUMBER 5]
Medical Insurance
$[NUMBER 6]
$[NUMBER 7]
Dental Insurance
$[NUMBER 8]
$[NUMBER 9]
TOTAL COST
$[NUMBER 10]
$[NUMBER 11]

Hoping for your consideration regarding this matter.

Regards,

[YOUR SIGNATURE]

[YOUR NAME]