Dependant termination request

With our new extended dependant rules, you’re now able to stay on your family’s policy until you turn 31, so long as you’re not married or in a de facto relationship. How good is that?

We’re all ready to put you back onto your family’s cover. To get things rolling, we just need your permission to cancel your current health insurance policy (with TUH or another health insurer – it doesn’t matter which).

Please complete and submit the following form and we’ll take care of the rest.

Dependant termination request

I authorise TUH to cancel my current private health insurance policy.

Given name *

Surname *

Date of birth *

Day

Month

Year

Current health insurer *

Member number *

Date effective from *

Nominated future date (if selected above)

Day

Month

Year

I declare that:

The information I’ve provided in this request is correct and complete;
I am not married or in a de facto relationship;
I agree to be bound by the Fund Rules and Constitution of Union Health as amended from time to time;
I am aware of that details of Union Health's privacy policy and I consent to Union Health collecting, using and/or disclosing my personal information for the purposes stated in the policy; and
I am aware that I have a 30 day cooling-off period

I have read and agree to the above declaration *

Yes

Policy cancellation request

I authorise TUH to cancel my current private health insurance policy.