Writing a Dental Insurance Cancellation Letter [Free Sample]

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Individuals who wish to cancel a dental insurance policy will need to do so in writing.  A letter prevents policy holders from having to talk directly to the representative of a company. 

Writing a dental insurance cancellation letter can easily be done by following a set of steps.

Canceling a dental insurance policy can be done at any time. dental insurance policies do not have any type of restriction that limits rights to cancel a policy. 

Review the information included with the policy to ensure the proper cancellation procedure is used. The next step is to prepare a rough draft of the dental insurance cancellation letter.

Prepare Rough Draft

A rough draft can be typed in a text editor on a computer or a regular piece of paper. The first thing to state on the rough draft is the date. This needs to placed in the upper left corner of the document.

Write or type the name on the policy and their address below the date. Below the address is the name of the insurer. Include the contact person if addressing an agent or company representative. A subject line will go on the next line with the account number.

Opening Paragraph

Begin the opening paragraph by requesting the cancellation of the dental insurance policyMake sure to add a sentence stating that all charges or debits for payment be stopped. The next sentence should state the date when the policy is to be effectively canceled.

Make sure to send any payments that are due if the letter is not ready to send before the monthly premium due date. 

The dental insurance company will refund any premium that was overpaid. If the policy has a cash value, then request that the amount be paid by check when sending any premium refunds.

sample Dental Insurance Cancellation Letter


Name on Policy Address of Policy Holder City, State, Zip

XYZ Insurance Company Address of Company City, State, Zip

ATT: Cancellations

RE: Dental Insurance Policy #

Please consider this letter as a formal request to cancel the referenced dental insurance policy. Please stop all debits or charges for premium payments. The effective date of policy cancellation is DATE.

I am also requesting written confirmation of the cancellation and the return of any premiums. The cash value of the policy should also be sent with any returned premium.

This action needs to occur within a period of 30 days from the receipt of this letter.


Name of Policy Holder

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