TO HEALTH BENEFITS INSURER REQUESTING REIMBURSEMENT FOR EXPENSES
I enclose a completed medical claim form together with receipts totaling $[AMOUNT OF RECEIPTS, ex. $233.29] in respect of [DESCRIBE NATURE OF AMOUNTS PAID, ex. minor surgery administered to our employee, [NAME OF EMPLOYEE].
Kindly provide us with a Check payable to the employee in the above amount.
Please address all correspondence to our address noted on our letterhead and marked “Personal and Confidential”.