Rescission letter template 2025

1. Click ‘Get Form’ to open the rescission letter template in the editor.
2. Begin by entering your company letterhead at the top of the document, including your logo and contact information.
3. Fill in the date on which you are submitting the rescission letter.
4. In the address section, input the details of the Commissions/Licensing Department at Independence Blue Cross.
5. Clearly state your group name and group number(s) for identification purposes.
6. In the body of the letter, specify your broker's name and company name, ensuring clarity about their role as Broker of Record.
7. Acknowledge any contractual obligations regarding health care coverage and payment processes as outlined in the template.
8. Conclude by signing off with your executive name and title, confirming your authority to submit this rescission request.

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