Change to Membership Details Request Form

  • Please use this form to update details on your Union Health membership. You can also access and update your membership details on Member Services Online

  • Only the main member or authorised spouse/partner may change membership details.

By completing this form, you agree to the Union Health Terms and Conditions and declaration listed on the form.

If you'd like to view how we collect and store your information you can view our privacy policy here.

Contact details

Complete only if any details have changed (if you’re not sure, please provide your current details).

 

My cover is for

If you require extended dependant cover, please select this option in addition to the single parent cover or family cover options. This option is available on all open hospital covers except Gold Hospital.

Cover type

Please select the cover required. Please refer to the product brochure(s) and the Important Information Guide before completing this section. Excess is per adult, per calendar year.

Persons affected

Person 1

Person 2

Person 3

Person 4

Surname change

Please note: If you are wanting to change a first name for a member on the policy, we will require evidence to action that request. Please send us an email (with attached evidence) to enquiries@tuh.com.au

Declaration

I declare that:
• The information I’ve provided in this request is correct and complete;
• I agree to be bound by the Fund Rules and Constitution of 'TUH (Union Health)' as amended from time to time;
• I understand that any changes to my cover may change my premiums;
• I have had the opportunity to read the Important Information Guide and the product brochure for my cover;
• I understand the terms and conditions of my cover, including the benefit entitlements, waiting periods, pre-existing conditions rules, exclusions, restrictions and excesses that may apply;
• I am aware that details of Union Health's privacy policy are available here and I consent to Union Health collecting, using and/or disclosing my personal information for the purposes stated in the policy;
• (If applicable) I am authorised to act on behalf of my partner and/or dependants that I have named in this request; and
• I am aware that I have a 30 day cooling-off period that commences from the change of cover date.
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