TO HEALTH BENEFITS INSURER REQUESTING REIMBURSEMENT FOR EXPENSES

Dear Felix

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”.

Regards
Lydia