Cancel Association

Please complete the following form to request cancellation of your association membership.


IMPORTANT:

Don’t end your Association membership until you know for sure when your new coverage starts. Once you end Association membership, you can’t re-enroll until the next annual Enrollment Period.


Your state provided professional license number. If multiple, provide your most recent.
The state which issued your professional license number. If multiple, provide your most recent.

IMPORTANT CANCELLATION NOTICE

Before proceeding with the cancellation of your Association membership, it is critical to understand the significant, potentially irreversible consequences that may impact you and your family:

  1. LOSS OF ACCESS TO LIFE, HEALTH, DISABILITY, AND RETIREMENT PROGRAMS
    Your membership in the Association grants you exclusive access to valuable programs, including life insurance, health insurance, disability, and retirement options. By canceling, you will immediately lose the opportunity to participate in these programs, leaving you and your family without essential protections and financial planning options that are not available elsewhere.
  2. LIMITED OR NO FUTURE ENROLLMENT OPPORTUNITIES
    The Association’s benefits, including access to life and health insurance, may not be available to you in the future if you choose to cancel now. Re-enrollment opportunities are limited and may come with higher premiums, stricter qualifications, or outright denial, particularly if your health or age has changed.
  3. LOSS OF GOVERNMENT SUBSIDIES AND FINANCIAL SUPPORT
    As an Association member, you may currently receive government subsidies and financial support. Canceling your membership may impact future qualifying, which can result in significantly higher costs for healthcare and other essential services, leaving you without affordable alternatives.
  4. RISK TO YOUR FAMILY’S FINANCIAL AND HEALTH SECURITY
    The Association’s programs are designed to protect not only you but also your immediate family members. Canceling your membership will mean that your loved ones will lose access to life-saving health coverage, retirement savings options, and other vital financial protections. This could leave your family vulnerable in the event of illness, injury, or other life-altering events.
  5. EXCLUSIVE ACCESS FOR LICENSED PROFESSIONALS ONLY
    Remember, the Association is available only to state-licensed professionals and their immediate family members. Once you cancel, rejoining may not be possible, and you and your family will no longer be eligible for these exclusive programs and services.

Please consider the long-term impact of canceling your membership. The benefits you are giving up may be difficult or impossible to replace. If you have any questions or would like to explore alternative solutions, our team is here to assist you in finding the best path forward to ensure your protection and peace of mind.

 

Confirm Your Identity

To process a cancellation request, we require your Date of Birth and the last four digits of your Social Security Number due to the sensitive financial nature of these services. This ensures the security and accuracy of your request.

 

Policyholder date of birth
or last 4 of TIN or USCIS
Clear Signature
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