[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] [Name of Medical Plan Administrator] [Medical Plan Administrator's Address] [City, State, ZIP Code] Subject: Authorization to Participate in Medical Plan — [Your Name] Dear [Medical Plan Administrator's Name], I hope this letter finds you well. I am writing to formally request authorization to participate in the medical plan offered by [Company/Organization Name]. As an employee/member, I fully understand the importance of obtaining appropriate healthcare coverage and believe that enrolling in the [Medical Plan Name] is vital for maintaining my health and the well-being of my family. As a resident of Phoenix, Arizona, I am deeply appreciative of the comprehensive medical benefits provided by [Company/Organization Name]. The Phoenix metropolitan area is home to a diverse population with a wide range of healthcare needs. Access to quality healthcare services is crucial for residents, and I am pleased to express my interest in being a part of this esteemed medical plan. I understand that by participating in the medical plan, I will have access to a myriad of healthcare benefits, including but not limited to: 1. Primary Care Physician (PCP) Selection: One of the fundamental aspects of the medical plan is the ability to choose a primary care physician who will oversee my general healthcare needs. I am aware of the importance of having a dedicated healthcare professional who can monitor and coordinate my medical treatments and ensure preventive care measures are in place. 2. Specialist Referrals: In the event that specialized medical attention is required, the medical plan offers the ability to obtain referrals to qualified specialists within the network. This ensures that any specialized treatments or consultations I may need will be accessible and covered under the plan. 3. Prescription Coverage: The medical plan also includes coverage for prescription drugs, enabling me to have affordable access to necessary medications prescribed by my healthcare providers. Having this benefit will not only enhance my overall health but also ease any financial burdens associated with medication expenses. 4. Hospitalization and Emergency Care: The medical plan provides vital coverage for hospital stays, surgeries, and emergency care services. This comprehensive coverage grants me peace of mind, knowing that I will receive necessary care in times of unforeseen medical emergencies. Furthermore, I am aware that Phoenix, Arizona is known for its vibrant healthcare industry, with numerous healthcare providers and facilities operating within the area. By being a part of the [Medical Plan Name], I will have access to a vast network of healthcare professionals, clinics, hospitals, and specialized centers, allowing me to choose the most suitable options for my medical needs. I hereby authorize [Company/Organization Name] to deduct the appropriate premiums from my salary on a regular basis to ensure seamless participation in the medical plan. I understand that my continued eligibility for this plan is contingent upon my employment/membership status with [Company/Organization Name]. Please find attached the necessary enrollment forms, completed and signed as required. Should any additional documents be necessary to complete my participation in the medical plan, kindly let me know, and I will provide them promptly. Thank you for considering my request for authorization to participate in the medical plan. I truly value the benefits this plan offers and the opportunity to ensure comprehensive healthcare coverage for myself and my family. If you require any further information or have any questions, please do not hesitate to contact me at [Phone Number] or [Email Address]. I look forward to a positive response and appreciate your prompt attention to this matter. Sincerely, [Your Name]
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.