Disenrollment Process

When can you end your membership in Provider Partners Health Plans?

You can end your membership in Provider Partner Health Plans at any time. Most people with Medicare can end their membership only during certain times of the year. However, because you live in a nursing home you can end your membership at any time.

For more information about ending your membership see Chapter 10 Section 2 of your Evidence of Coverage.

How do you end your membership in Provider Partners Health Plans?

Usually, you end your membership by enrolling in another plan. For more information about how to end your membership see Chapter 10 Section 3 of your Evidence of Coverage.

Until your membership ends, you are still a member of our plan

If you leave Provider Partners Health Plans, it may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan.

• You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services.
• If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).

Provider Partners Health Plans must end your membership in the plan in certain situations

Provider Partners Health Plans must end your membership in the plan if any of the following happen:

• If you no longer have Medicare Part A and Part B.
• If you move out of our service area.
• If you are away from our service area for more than six 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.
• You do not meet the plan’s special eligibility requirements as stated in Chapter 1, Section 2.1 as noted in the EOC.
• If you become incarcerated (go to prison).
• If you are not a United States citizen or lawfully present in the United States.
• If you lie about 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. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other 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 membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
• If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.