Cancel an Enrolled Employee's UPC Membership

We’re hard at work adding this functionality into our Portal directly so that you see your changes in real time! In the meantime, rest assured that our team will receive and execute all form submissions within a business day.

Cancel an Enrolled Employee's UPC Membership

Employer Name(Required)

Your Name

First Last

Employee Name(Required)

First Last

Employee Email(Required)

Effective Date(Required)

Effective Date defaults to the last day of the current month. If it is past the 25th of the current month, it will be the last day of the next full month. If a cancelation occurs on March 24, it will be effective March 31. If a cancelation occurs on March 26, it will be effective April 30.

Cancelation Reason(Required)