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How to Disenroll

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Voluntary Disenrollment

If you are considering disenrollment, please call our Member Advocacy Department at 1-866-334-3141 (TTY: 7-1-1 or 1-800-735-2989). We want to help you in any way we can. Our Member Advocates can help you resolve problems before you make the final decision to change health plans.

Medicare gives you two periods per year when you can disenroll from a Medicare Advantage plan:

  • Annual Election Period (AEP), Oct. 15 – Dec. 7
  • Medicare Advantage Disenrollment Period (MADP), Jan. 1 – Feb. 14

If your situation includes the following, you can enter a Special Enrollment Period:

  • You move outside our service area, or have experienced another change in circumstances — as determined by the Centers for Medicare & Medicaid Services (CMS) — that causes you to no longer be enrolled in a SWHP Medicare Advantage plan
  • You’re entitled to Medicare Part A and Part B and receive any type of assistance from the Title XIX (Medicaid) program
  • CMS or the organization has terminated our contract in the area in which you reside, or the organization has notified you of the impending termination or discontinuation of the plan in the area you reside
  • You demonstrate that we have substantially violated a material provision of our contract with CMS in relation to you, or we (or an agent) materially misrepresented the plan when marketing our plans
  • You weren’t adequately informed of the creditable status of drug coverage provided by an entity required to give such notice, or a loss of creditable coverage
  • Your enrollment or non-enrollment is erroneous due to an action, inaction, or error by a federal employee
  • You meet such other exceptional conditions as CMS may provide

Ways to disenroll during AEP, MADP, or valid Special Enrollment Period:

  • Call us at 1-866-334-3141 (TTY: 7-1-1 or 1-800-735-2989)
  • Call 1-800-MEDICARE
  • Deliver or fax a signed and dated written notice to the plan
  • Enroll in another plan during a valid enrollment period, which will prompt disenrollment in your current plan. Use your current plan until disenrollment is effective

Involuntary Disenrollment

We may disenroll you if:

  • Premiums are not paid on a timely basis
  • You engage in disruptive behavior
  • You provide fraudulent information on an enrollment request
  • You permit abuse of an enrollment card

If we choose to terminate your coverage for any of these reasons, we’ll send you notice of the upcoming disenrollment. This notice will:

  • Advise you we plan to disenroll you, and why such action is occurring
  • Provide the effective date of termination
  • Include an explanation of your right to a hearing under our grievance procedures

Required Involuntary Disenrollment

We are required to disenroll you if:

  • A permanent change in residence makes you ineligible to be an enrollee of our advantage plans
  • You lose entitlement to Medicare
  • You die
  • Our contract is terminated, or we discontinue offering a Prescription Drug Plan in the area where it had previously been available*
  • You materially misrepresent information to us regarding reimbursement for third-party coverage

*Authorized by law to refuse to renew its contract with CMS. In addition, CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment.