Member Rights – Disenrollment Rights

Ending your membership in Senior Care Plus 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 only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. There are also limited situations where you do not choose to leave, but we are required to end your membership. If you are leaving our plan, you must continue to get your medical care and prescription drugs through our plan until your membership ends.

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year.

You can end your membership during the Annual Enrollment Period (also known as the “Annual Coordinated Election Period”). This is the time when you should review your health and drug coverage and make a decision about your coverage for the upcoming year. This happens from October 15 to December 7. During this time, you can review your health coverage and your prescription drug coverage. You can choose to keep your current coverage or make changes to your coverage for the upcoming year. If you decide to change to a new plan, you can choose any of the following types of plans:

Another Medicare health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)

• Original Medicare with a separate Medicare prescription drug plan.
• – or – Original Medicare without a separate Medicare prescription drug plan.
• If you receive Extra Help from Medicare to pay for your prescription drugs: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.) Your membership will end when your new plan’s coverage begins on January 1.

You have the opportunity to make one change to your health coverage during the annual Medicare Advantage Disenrollment Period. This happens every year from January 1 to February 14. During this time, you can cancel your Medicare Advantage Plan enrollment and switch to Original Medicare. If you choose to switch to Original Medicare during this period, you have until February 14 to join a separate Medicare prescription drug plan to add drug coverage. Your membership will end on the first day of the month after we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.

In certain situations, members of Senior Care Plus may be eligible to end their membership at other times of the year. This is known as a Special Enrollment Period. If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period. These are just examples, for the full list you can contact the plan, call Medicare, or visit the Medicare website. Following this link will take you out of the Senior Care Plus website.

• Usually, when you have moved.
• If you have Nevada Medicaid.
• If you are eligible for Extra Help with paying for your Medicare prescriptions.
• If we violate our contract with you.
• If you are getting care in an institution, such as a nursing home or long-term care hospital.
• If you enroll in the Program of All-inclusive Care for the Elderly (PACE).

The enrollment periods vary depending on your situation. To find out if you are eligible for a Special Enrollment Period, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048. If you are eligible to end your membership because of a special situation, you can choose to change both your Medicare health coverage and prescription drug coverage. This means you can choose any of the following types of plans:

• Another Medicare health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
• Original Medicare with a separate Medicare prescription drug plan.
• – or – Original Medicare without a separate Medicare prescription drug plan.
• If you receive Extra Help from Medicare to pay for your prescription drugs: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.) See Chapter 6, Section 10 for more information about the late enrollment penalty. Your membership will usually end on the first day of the month after we receive your request to change your plan.

If you have any questions or would like more information on when you can end your membership, you can call Customer Service at 775-982-3112 or 888-775-7003 (TTY users call the State Relay Service at 711) from 7 a.m. to 8:00 p.m PST Monday–Friday.  You can also find the information in the Medicare & You Handbook. Everyone with Medicare receives a copy of Medicare & You each fall. Those new to Medicare receive it within a month after first signing up. You can also download a copy from the Medicare website Or, you can order a printed copy by calling Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan during one of the enrollment periods. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:

• You can make a request in writing to us.
• –or–You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage).

If you leave Senior Care Plus, 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).

Senior Care Plus must end your membership in the plan if any of the following happen:

• If you do not stay continuously enrolled in 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 Customer Service to find out if the place you are moving or traveling to is in our plan’s area.
• If you have been a member of our plan continuously since before January 1999 and you were living outside of our service area before January 1999, you may continue your membership. However, if you move and your move is to another location that is outside of our service area, you will be disenrolled from our plan.
• If you become incarcerated (go to prison).
• 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 do not pay the plan premiums for 90 days.
• We must notify you in writing that you have 90 days to pay the plan premium before we end your membership.
• 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.

If you have questions or would like more information on when we can end your membership you can call Customer Service for more information at 775-982-3112 or 888-775-7003 (TTY users call the State Relay Service at 711) from 7 a.m. to 8:00 p.m PST Monday–Friday. If you feel that you are being asked to leave our plan because of a health-related reason, you should call Medicare at 1-800-MEDICARE (1-800-633-4227).

TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week. If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership.