Disenrollment Rights and Responsibilities

Transcription

1 Disenrllment Rights and Respnsibilities Yu may end yur membership in ur plan nly during certain times f the year, knwn as enrllment perids. All members have the pprtunity t leave the plan during the Annual Enrllment Perid and during the annual Medicare Advantage Disenrllment Perid. In certain situatins, yu may als be eligible t leave the plan at ther times f the year. Yu can end yur membership during the Annual Enrllment Perid Yu can end yur membership during the Annual Enrllment Perid (als knwn as the Annual Crdinated Electin Perid ). This is the time when yu shuld review yur health and drug cverage and make a decisin abut yur cverage fr the upcming year. When is the Annual Enrllment Perid? This happens frm Octber 15 t December 7. What type f plan can yu switch t during the Annual Enrllment Perid? During this time, yu can review yur health cverage and yur prescriptin drug cverage. Yu can chse t keep yur current cverage r make changes t yur cverage fr the upcming year. If yu decide t change t a new plan, yu can chse any f the fllwing types f plans: Anther Medicare health plan. (Yu can chse a plan that cvers prescriptin drugs r ne that des nt cver prescriptin drugs.) Original Medicare with a separate Medicare prescriptin drug plan. r Original Medicare withut a separate Medicare prescriptin drug plan. If yu receive Extra Help frm Medicare t pay fr yur prescriptin drugs: If yu switch t Original Medicare and d nt enrll in a separate Medicare prescriptin drug plan, Medicare may enrll yu in a drug plan, unless yu have pted ut f autmatic enrllment. Nte: If yu disenrll frm Medicare prescriptin drug cverage and g withut creditable prescriptin drug cverage, yu may need t pay a late enrllment penalty if yu jin a Medicare drug plan later. ( Creditable cverage means the cverage is expected t pay, n average, at least as much as Medicare s standard prescriptin drug cverage.) See Chapter 6, Sectin 10 f the EOC fr mre infrmatin abut the late enrllment penalty. When will yur membership end? Yur membership will end when yur new plan s cverage begins n January 1.

2 Yu can end yur membership during the annual Medicare Advantage Disenrllment Perid, but yur chices are mre limited Yu have the pprtunity t make ne change t yur health cverage during the annual Medicare Advantage Disenrllment Perid. When is the annual Medicare Advantage Disenrllment Perid? This happens every year frm January 1 t February 14. What type f plan can yu switch t during the annual Medicare Advantage Disenrllment Perid? During this time, yu can cancel yur Medicare Advantage Plan enrllment and switch t Original Medicare. If yu chse t switch t Original Medicare during this perid, yu have until February 14 t jin a separate Medicare prescriptin drug plan t add drug cverage. When will yur membership end? Yur membership will end n the first day f the mnth after we get yur request t switch t Original Medicare. If yu als chse t enrll in a Medicare prescriptin drug plan, yur membership in the drug plan will begin the first day f the mnth after the drug plan gets yur enrllment request. In certain situatins, yu can end yur membership during a Special Enrllment Perid In certain situatins, members f Baptist Health Plan Advantage may be eligible t end their membership at ther times f the year. This is knwn as a Special Enrllment Perid. Wh is eligible fr a Special Enrllment Perid? If any f the fllwing situatins apply t yu, yu are eligible t end yur membership during a Special Enrllment Perid. These are just examples, fr the full list yu can cntact the plan, call Medicare, r visit the Medicare website ( Usually, when yu have mved. If yu have Medicaid. If yu are eligible fr Extra Help with paying fr yur Medicare prescriptins. If we vilate ur cntract with yu. If yu are getting care in an institutin, such as a nursing hme r lng-term care (LTC) hspital. When are Special Enrllment Perids? The enrllment perids vary depending n yur situatin. What can yu d? T find ut if yu are eligible fr a Special Enrllment Perid, please call Medicare at MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users call If yu are eligible t end yur membership

3 because f a special situatin, yu can chse t change bth yur Medicare health cverage and prescriptin drug cverage. This means yu can chse any f the fllwing types f plans: Anther Medicare health plan. (Yu can chse a plan that cvers prescriptin drugs r ne that des nt cver prescriptin drugs.) Original Medicare with a separate Medicare prescriptin drug plan. r Original Medicare withut a separate Medicare prescriptin drug plan. If yu receive Extra Help frm Medicare t pay fr yur prescriptin drugs: If yu switch t Original Medicare and d nt enrll in a separate Medicare prescriptin drug plan, Medicare may enrll yu in a drug plan, unless yu have pted ut f autmatic enrllment. Nte: If yu disenrll frm Medicare prescriptin drug cverage and g withut creditable prescriptin drug cverage, yu may need t pay a late enrllment penalty if yu jin a Medicare drug plan later. ( Creditable cverage means the cverage is expected t pay, n average, at least as much as Medicare s standard prescriptin drug cverage.) See Chapter 6, Sectin 10 f the EOC fr mre infrmatin abut the late enrllment penalty. When will yur membership end? Yur membership will usually end n the first day f the mnth after yur request t change yur plan is received. Where can yu get mre infrmatin abut when yu can end yur membership? If yu have any questins r wuld like mre infrmatin n when yu can end yur membership: Yu can call Member Services at r TTY Yu can find the infrmatin in the Medicare & Yu Handbk. Everyne with Medicare receives a cpy f Medicare & Yu each fall. Thse new t Medicare receive it within a mnth after first signing up. Yu can als dwnlad a cpy frm the Medicare website ( Or, yu can rder a printed cpy by calling Medicare at the number belw. Yu can cntact Medicare at MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users shuld call Usually, yu end yur membership by enrlling in anther plan Usually, t end yur membership in ur plan, yu simply enrll in anther Medicare plan during ne f the enrllment. Hwever, if yu want t switch frm ur plan t Original Medicare

4 withut a Medicare prescriptin drug plan, yu must ask t be disenrlled frm ur plan. There are tw ways yu can ask t be disenrlled: Yu can make a request in writing t us. Cntact Member Services if yu need mre infrmatin n hw t d this at r TTY r--yu can cntact Medicare at MEDICARE ( ), 24 hurs a day, 7 days a week. TTY users shuld call Nte: If yu disenrll frm Medicare prescriptin drug cverage and g withut creditable prescriptin drug cverage, yu may need t pay a late enrllment penalty if yu jin a Medicare drug plan later. ( Creditable cverage means the cverage is expected t pay, n average, at least as much as Medicare s standard prescriptin drug cverage.) See Chapter 6, Sectin 10 f the EOC fr mre infrmatin abut the late enrllment penalty. The table belw explains hw yu shuld end yur membership in ur plan. If yu wuld like t switch frm ur plan t: This is what yu shuld d: Anther Medicare health plan. Enrll in the new Medicare health plan. Yu will autmatically be disenrlled frm Baptist Health Plan Advantage when yur new plan s cverage begins. Original Medicare with a separate Medicare prescriptin drug plan. Enrll in the new Medicare prescriptin drug plan. Yu will autmatically be disenrlled frm Baptist Health Plan Advantage when yur new plan s cverage begins. Original Medicare withut a separate Medicare prescriptin drug plan. Nte: If yu disenrll frm a Medicare prescriptin drug plan and g withut creditable prescriptin drug cverage, yu may need t pay a late enrllment penalty if yu jin a Medicare drug plan later. See Chapter 6, Sectin 10 f the EOC fr mre infrmatin abut the late enrllment penalty. Send us a written request t disenrll. Cntact Member Services if yu need mre infrmatin n hw t d at r TTY Yu can als cntact Medicare, at MEDICARE ( ), 24 hurs a day, 7 days a week, and ask t be disenrlled. TTY users shuld call Yu will be disenrlled frm Baptist Health Plan Advantage when yur cverage in Original Medicare begins.

5 Until yur membership ends, yu are still a member f ur plan If yu leave Baptist Health Plan Advantage, it may take time befre yur membership ends and yur new Medicare cverage ges int effect. During this time, yu must cntinue t get yur medical care and prescriptin drugs thrugh ur plan. Yu shuld cntinue t use ur netwrk pharmacies t get yur prescriptins filled until yur membership in ur plan ends. Usually, yur prescriptin drugs are nly cvered if they are filled at a netwrk pharmacy including thrugh ur mail-rder pharmacy services. If yu are hspitalized n the day that yur membership ends, yur hspital stay will usually be cvered by ur plan until yu are discharged (even if yu are discharged after yur new health cverage begins). When must we end yur membership in the plan? Baptist Health Plan Advantage must end yur membership in the plan if any f the fllwing happen: If yu d nt stay cntinuusly enrlled in Medicare Part A and Part B. If yu mve ut f ur service area. If yu are away frm ur service area fr mre than six mnths. If yu mve r take a lng trip, yu need t call Member Services t find ut if the place yu are mving r traveling t is in ur plan s area. If yu becme incarcerated (g t prisn). If yu lie abut r withhld infrmatin abut ther insurance yu have that prvides prescriptin drug cverage. If yu intentinally give us incrrect infrmatin when yu are enrlling in ur plan and that infrmatin affects yur eligibility fr ur plan. (We cannt make yu leave ur plan fr this reasn unless we get permissin frm Medicare first.) If yu cntinuusly behave in a way that is disruptive and makes it difficult fr us t prvide medical care fr yu and ther members f ur plan. (We cannt make yu leave ur plan fr this reasn unless we get permissin frm Medicare first.) If yu let smene else use yur membership card t get medical care. (We cannt make yu leave ur plan fr this reasn unless we get permissin frm Medicare first.)

6 If we end yur membership because f this reasn, Medicare may have yur case investigated by the Inspectr General. If yu are required t pay the extra Part D amunt because f yur incme and yu d nt pay it, Medicare will disenrll yu frm ur plan and yu will lse prescriptin drug cverage. Where can yu get mre infrmatin? If yu have questins r wuld like mre infrmatin n when we can end yur membership: Yu can call Member Services fr mre infrmatin at r TTY We cannt ask yu t leave ur plan fr any reasn related t yur health Baptist Health Plan Advantage is nt allwed t ask yu t leave ur plan fr any reasn related t yur health. What shuld yu d if this happens? If yu feel that yu are being asked t leave ur plan because f a health-related reasn, yu shuld call Medicare at MEDICARE ( ). TTY users shuld call Yu may call 24 hurs a day, 7 days a week. Yu have the right t make a cmplaint if we end yur membership in ur plan If we end yur membership in ur plan, we must tell yu ur reasns in writing fr ending yur membership. We must als explain hw yu can make a cmplaint abut ur decisin t end yur membership. Yu can lk in Chapter 9, Sectin 10 f the EOC fr infrmatin abut hw t make a cmplaint.