We regret to inform you that on [date], you will no longer be eligible for [coverage or benefit]. The reason for this termination of benefits is [dismissal/departure/change in service provider].
You can expect additional information to be sent by [communication method] by [date].
We have provided the following resources for you to investigate replacement coverage, but we do not guarantee eligibility. [List resources.]
Failure to complete the following steps could result in total loss of coverage under the benefits in question. [List necessary employee actions.]
For more information, please contact [point of contact's phone number, email and mailing address].
Sincerely, [employer]
"