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Sample Termination of Health Insurance

Robert Davis
Insurance Company “Alfa”
33 Kenton Street
Toronto, Canada 45478

Elvan Adams
437 Ridley Street
Toronto, Canada 45478

May, 27, 2010

Dear Mr. Adams,
Unfortunately, the Repayment Period for health benefits has run out and we have not received your indebtedness of $75 which was due on May, 26, 2010. If you do not pay off the debt within 15 days after you receive this notification your health insurance will be terminated.
For your information, termination of health benefits on the score of nonpayment of insurance fees is regarded as voluntary cancellation by the policy owner. If your registration for health insurance is cancelled, you may not be registered again. However if your health benefits coverage is cancelled, it may be reinstated only if you were impeded by reasons beyond your control. You may be reinstated by writing to the following address: 33 Kenton Street, Toronto, Canada 45478.

Robert Davis
“Alfa” Agency Official