Helpful Information Disenrollment Rights and Responsibilities

Disenrollment Rights and Responsibilities

Ending your membership in our plan may be voluntary (your own choice) or involuntary (not your own choice):

• You might leave our Plan because you have decided that you want to leave.
• There are also limited situations where we are required to end your membership. For example, if you move permanently out of our geographic service area.

Voluntarily ending your membership

There are only certain times during the year when you may voluntarily end your membership in our plan. The key time to make changes is the Medicare Advantage Annual Enrollment period (October 15th to December 7th). You can also end your membership during the Medicare Advantage Annual Disenrollment period (January 1st to February 14th), but your choices are more limited. For more information on when you can make changes, click Key Enrollment Dates for more information on times that you can make changes to your enrollment.

Involuntarily ending your membership

If any of the following situations occur, we will end your membership in our plan.

• If you do not stay continuously enrolled in Medicare A or B (or both).
• If you move out of the service area for more than 6 months. If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area.
• If you become incarcerated.
• If you knowingly lie or withhold information about other insurance you have that provides prescription drug coverage.
• If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you or others who are members of our plan. We cannot make you leave our plan for this reason unless we get permission from Medicare first.
• If you let someone else use your plan membership card to get medical care. If we end your membership for this reason, CMS may have your case investigated by the Inspector General.
• If you do not pay the plan premiums, we will tell you in writing that you have a three calendar month grace period during which you may pay the plan premiums before your membership ends.

You have the right to make a complaint if we end your membership in our plan

If we end your membership in our plan we will tell you our reasons in writing and explain how you may file a complaint against us if you want to.

For more information about voluntary or involuntary disenrollment, contact Member Services or refer to the Evidence of Coverage.

H8578_2016_049 Approved
The information on this page was last updated on 2/18/2016