Hardship Letter for Health Care Exemption

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}

Index of Hardship Letter Examples