Adding/Deleting a Family Member

There are many life events that occur that will necessitate a change to your TDP enrollment. Occasionally, you may need to add or delete enrolled TDP family members.

Reasons for adding a family member may include:

• Marriage
• Birth
• Adoption
• Stepchild or ward newly eligible for TDP
• Add child before turning age 4

Note: If you are adding a family member to a single plan, your premium will increase to the family plan rate.

Reasons for deleting a family member include:

• Death
• Divorce
• Child moves away
• Loss of eligibility

How to Add or Delete
United Concordia provides you with three convenient options for adding and deleting family members:

1. Change It Online
   To add or delete a family member online, access 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 enrollment 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.