Hardship Letter Template For Health Care Exemption printable pdf download

Hardship Letter Template For Health Care Exemption

{Your Name}

{Your Address}

{Date}

To Whom It May Concern:

I am writing to request an exemption from the new health care coverage that will

go into effect on {date}. I would like to maintain my current plan, as the new one

will be detrimental to my family and cause extreme financial hardship.

The old coverage cost us {amount} per month for a(n) {amount} deductible and

a(n) {amount} copay. The new health care plan would require us to pay {amount}

per month for a(n) {amount} deductible, which will cost me {amount} more per

month for less coverage.

While I understand that in many cases, not having access to employer health

insurance will result in savings costs for employees, this is definitely not the case

for our family. While I earn approximately {income} annually in gross wages, my

{husband/wife} makes {amount} per year with no company insurance, which puts

our {number}-person family over the income cutoff to qualify for subsidies/tax

credits under the Affordable Care Act’s State Exchange. We would also be

receiving no vision or dental as well as a higher copay. It’s a big step down from

the generous, affordable policy we’ve enjoyed through {Company Name}. We got

quotes from a local insurance agent and they were just as difficult for our

financial situation.

It is vital that we retain our current coverage. Not only does our family have

ongoing health care needs, we have been counting on the {aspect} in order to

provide {care} for our children. I have attached a copy of our {year} tax return as

well as pay stubs and a copy of our recent health care costs. Thank you for your

consideration.

Sincerely,

{Sender Name}

Hardship Letter Template For Health Care Exemption