Canceling Coverage

You must remain enrolled in the TDP for a minimum of 12 months. You may choose to disenroll from the TDP once you meet your 12-month initial enrollment period or if you have a valid reason to disenroll. For a list of valid reasons to disenroll (cancel coverage), please review the Disenrolling Before the Initial Enrollment Period section.

There are three convenient ways to disenroll from the TDP:

1. Disenroll Online
   Disenroll online by accessing the TDP Online Enrollment/Change Form.
2. Mail It
   The TDP Enrollment/Change Form can be downloaded and mailed to United Concordia at the following address:
   
         United Concordia/TDP
         P.O. Box 827583
         Philadelphia, PA 19182-7583
3. Fax It
   Fax your TDP Enrollment/Change Form to 1-888-734-1944.

Note: The sponsor must complete the TDP Enrollment/Change Form and forward it to United Concordia for processing. If the sponsor is not available to complete and sign the form, an individual with a Power of Attorney (POA) can initiate disenrollment only if the POA allows the individual to enter into contracts. A copy of the valid POA must be submitted with the TDP Enrollment/Change Form.

Cancellation Policy
If the TDP Enrollment/Change Form is received by the 20th of the month, the cancellation will be processed for the first day of the following month. If the form is received after the 20th of the month, the cancellation will be processed for the first day of the second month following.

For example: If your cancellation notification is received by June 20, the cancellation will take effect on July 1. If your cancellation notification is received on June 21 or through the end of the month of June, the cancellation will take effect on August 1.

Cancellation is processed according to the date of receipt, not by a postmark date or the date on the TDP Enrollment/Change Form.

You are responsible for all monthly premiums until coverage is cancelled.