Membership Suspension Request

Membership Suspension Request Form

Union Health will allow you to suspend your health fund membership if you are living or travelling outside of Australia or if you or your partner are experiencing financial hardship.

Please read the conditions for membership suspension before completing this request.

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.

Member name *

Membership number *

Request type *

Overseas suspension

Financial hardship

Overseas suspension

You may suspend your membership if you are living or travelling outside of Australia for a minimum of two calendar months and a maximum of three years.

Departure date *

Day

Month

Year

Flight/Cruise number *

Return date

Day

Month

Year

Flight/Cruise number

If return date is unknown, we’ll need additional written evidence to resume your membership when you return.

Will all people on your membership be travelling overseas with you?

Yes

If no, please list the names of person(s) covered on your policy who will be travelling overseas for the period of your overseas suspension.

Person 1

Person 2

Person 3

Person 4

Is your partner or dependent who is covered on your membership NOT travelling overseas with you?

Yes

I authorise my Union Health membership, including any associated payment authorities to be transferred into the name of my partner/dependant for the period of my trip. I understand payment of premiums during this period is my responsibility *

Yes

Overseas contact details

If you’re travelling for more than 6 months, we’ll notify you before your membership resumes.

Email address

Mobile number

Financial hardship

Union Health will consider suspending your membership due to financial hardship if you experience a loss of employment, significant decline in retirement income due to extraordinary circumstances, or significant extraordinary events such as natural disasters.

Please advise the date you wish to suspend your membership:

Start date

Day

Month

Year

Please note: Suspensions are granted for an initial period of six months with an option to extend to 12 months. So, the end date will be 6 months from the start date you have selected.

Please describe your situation to support your request *

I understand Union Health may require me to provide further information to support my request. *

Yes

Acknowledgement and declaration

I have read, understand and agree to be bound by the conditions that relate to a suspension of membership as included on this form and the current 'TUH (Union Health)' Fund Rules. I understand and accept that my personal information provided in this form, will be used in accordance with the Union Health Privacy Policy.

I have read and agree to the above declaration *

Yes