Health Insurance Cancellation Form Template

What is a health insurance cancellation form?

A health insurance cancellation form is a digital form used to officially terminate an individual's health insurance policy. It typically requires the policyholder to provide their personal information, policy details, and reasons for cancellation. The form ensures that the insurance provider is notified of the policyholder's decision to end their coverage.

Important fields to include in a health insurance cancellation form

Here are some key fields that you can include in your health insurance cancellation form. You can customize these fields according to your specific needs.

Field Name	Why to Collect	Compulsory/Optional	Input Type
Full name	To identify the policyholder	Compulsory	Text
Email address	To send confirmation and future communication	Compulsory	Email
Mobile number	To contact the policyholder if needed	Compulsory	Phone number
Policy number	To locate the policy in the system	Compulsory	Text
Effective date of cancellation	To record when the cancellation takes effect	Compulsory	Date selector
Reason for cancellation	To understand the policyholder's feedback	Compulsory	Dropdown
Other reason	To capture additional information if the reason is "Other"	Optional	Text
Notification to beneficiaries	To determine if they are aware of the cancellation	Compulsory	Dropdown
Additional comments	To provide any additional feedback or information	Optional	Text

How can I create a health insurance cancellation form?

You can create a health insurance cancellation form using any online tool that allows you to create forms, like Google Forms, Typeform, etc. You can also use Mailmodo to create and send forms in your emails.

How can I send a health insurance cancellation form in an email?

Before we get into the how, let’s understand the why.

Why should you send this form in an email?

Inserting your health insurance cancellation form in your emails allows you to reach out to your existing email list and have them fill out the form within the email itself. This reduces friction and cuts down on multiple steps like redirects, logging in to another page, etc., increasing the number of submissions.

For example, BluSmart saw a 35% increase in responses by sending interactive emails using Mailmodo.

Now, let’s come to the how.

If you want to send this health insurance cancellation form in an email, you can use Mailmodo. Mailmodo is an all-in-one interactive email marketing platform that lets you create and send such interactive forms in email without any coding. Here’s an interactive demo to get you started.

How to increase submissions for your health insurance cancellation form

You can increase the submissions of your health insurance cancellation form by making them user-centric and easy to complete. We’ve created an exclusive guide that discusses 12 things you can do to increase form submissions.