Letters on Company Letterhead

Acknowledgement / Election of COBRA / Continuation Right
This 2 page form is for the benefits administrator to send to an employee who has left the company or to the family of an employee who has passed away for them to elect COBRA / Continuation. Please complete the first page, photocopy for your files and send the 2 page form to the employee or family of the employee. The employee or family members have 60 days to enroll in COBRA / Continuation.

Act as Benefits Administrator
Please re-type this letter on company letterhead authorizing a person that is not listed on your payroll (your accountant, the owners husband/wife or adult child, business partner, etc.) to act as Benefits Administrator for your company.

BOR Aetna NJ
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Aetna NY
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Atlantis
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Cigna HealthCare
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Empire Blue Cross
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR General
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR GHI
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Guardian HealthNet
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR HIP
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Horizon HealthCare
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Oxford Health Plans
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR United HealthCare
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR Vytra Health Plans
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

BOR WellChoice
This Broker of Record Letter will replace your current broker with Forest Hills Group Services, Inc. Please re-type on your company letterhead and make sure you print the date, your policy number, your name and signature. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately. We will call you once the BOR has been approved.

Change on Plan Renewal
The Change on Plan Renewal must be typed on company letterhead and must dictate the plan design and rate you are requesting to be change to. You also must include your company name and policy number on the letter.ÝOnce completed, please fax this to (718) 268-0264 and we will fax this to the appropriate department immediately.

Cobra - NYS 18 months
This Cobra letter is to inform your former employee who has left through voluntary or involuntary dismissal that they are entitled to Cobra for 18 months. Please re-type on your company letterhead and send it to your former employee. Please see the Health Insurance Glossary for the complete reasons to elect 18 months of Cobra.

Cobra - NYS 36 months
This Cobra letter is to inform the family of an employee who passed away or a dependent student that has passed the dependent student age status that they are entitled to Cobra for 36 months. Please re-type on your company letterhead and send it to your former employee. Please see the Health Insurance Glossary for the complete reasons to elect 36 months of Cobra.

Company Name, Address & Employer Identification Number Change
This letter is to be re-typed by the Benefits Administrator and is to change your Company Name, Address and Employer Identification Number with your current group insurance plan. Please re-type on your company letterhead. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.

Off Anniversary Plan Downgrade
This letter is to be re-typed by the benefits administrator on company letterhead in order to Downgrade your Plan Off Anniversary. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.

Rehire Employee
This letter must be re-typed by the benefits administrator on company letterhead in order to rehire an important employee back. Once completed, please fax this to (718) 268-0264 and we will fax this to the appropriate department immediately.

Rescind Termination of Employee
This letter is to be re-typed by the benefits administrator on company letterhead in order to rescind the termination of an employee. This request can be made within 30 days of the date of termination for reinstatement. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.

Rescind Termination of Group
This letter is to be re-typed by the benefits administrator on company letterhead in order to rescind the termination of your group plan. This request can be made within 30 days of the date of termination for reinstatement. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.

Sample Student Verification
This letter must be received by the Bursars or Registration office of the college your student is currently attending. The letter must state that your student is maintaining full-time student status and it must state the current semester. A new letter will be requested at the beginning of each Spring, Summer and Fall semester. Once you have obtained this letter, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.

Segmentation of Group
This letter is to be re-typed by the benefits administrator on company letterhead in order to successfully segment the Owners/Mangement from the Staff/Employees. Once completed, please fax this to (718) 268-0264 and we will fax this to the appropriate department immediately.

Termination
This letter is to be re-typed by the benefits administrator on company letterhead in order to terminate your group plan. Once completed, please fax this to (718) 268 ‚ 0264 and we will fax this to the appropriate department immediately.