Simply replace the unfilled areas such as "" and "[date]" with your information.
Dear [HR Benefits Administrator],
I require your assistance to add my [dependent], [dependent name], to my health insurance policy. On [date], my [dependent] [state qualifying event]. Per the terms of my policy, this meets the criteria of a qualifying event. Therefore, I can now add [Dependent Name] to my insurance policy, rather than wait for an enrollment period. It is important to me that my family be protected by my insurance plan. I would like their coverage to start as soon as possible. Will you please help me process this change?
[Enclosed/Attached] are all of the documents needed to support this qualifying event. If there are any additional forms or information I should provide, please let me know. You may contact me at [contact information].