Sample Medigap Cancellation Letter

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Instruction Sheet for Sample Termination Letter
The following document relates to cancellation of other coverage when enrolling in a UnitedHealthcare
Medicare Advantage plan.
If a member is replacing a Medicare supplement plan (Medigap) with a UnitedHealthcare
Medicare Advantage plan, it’s important that:
1. Prior coverage is terminated and,
2. Requested effective date is correct.
The sample termination letter, found on the next page, can be used by the member to terminate prior
insurance coverage (i.e. Medicare supplement plan). The letter should be sent after receiving confirmation
of acceptance into the UnitedHealthcare Medicare Solutions plan. The termination date should coincide
with the new plan’s effective date.


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