Addition of Dependent to Insurance

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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].

Thank you,


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