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Transcription:

What happens if Medicare plans from Unitedcare leaves the Medicare Program or leaves the Service Area where you live? If we leave the Medicare program or discontinue Medicare plans from Unitedcare in your Service Area, we will notify you in writing. If either of these situations occurs, you will be allowed to change the way you receive Medicare coverage. Your choices will always include Original Medicare, and they may also include joining another Medicare Advantage Plan, if such plans are available in your area and are accepting new Members. We have a contract with CMS. At the end of each year, the contract is reviewed, and either we or CMS may decide to terminate the contract. It is also possible our contract may terminate at some other time. If the contract is going to terminate, we will generally notify you at least ninety (90) days in advance. Your advance notice may be as little as thirty (30) days, or even fewer days if CMS terminates our contract in the middle of the year. Until we notify you in writing that you must Disenroll from Medicare plans from Unitedcare and indicate the date when your membership ends, you will continue as a Member of Medicare plans from Unitedcare, and you must continue to receive all Covered from Contracted Medical Providers until the date your Disenrollment is effective. All Covered and rules described in this document will continue until your membership ends. Once we have notified you in writing we are leaving the Medicare program or the area where you live, you may switch to another way of getting your Medicare benefits at any time. If you decide to switch from Medicare plans from Unitedcare to Original Medicare, you will have the right to buy a Medigap policy regardless of your health. This is called guaranteed issue rights. Locate your state below to find the local agency to contact about how and when to buy a Medigap policy if you need one. Alabama Alabama Department of Senior 201 Monroe ST, STE 350 Montgomery, AL 36104 Phone: 1-800-243-5463 Arizona Arizona Department of Economic Security Division of Aging and Adult Alaska Senior and Disabilities 240 Main ST STE 601 Juneau, AK 99811-0680 Phone: 1-866-465-3165 TTY: 1-907-465-5430 Arkansas Senior Insurance Information Program 1200 West Third Street Little Rock, AR 72201- America Samoa American Samoa Department of A. P. Lutali Executive Office BLDG Pago Pago, AS 96799 Phone: 1-684-633-4606 California California Department of Aging 1300 National Drive, STE 200

1789 West Jefferson Street, ATTN: SHIP 950A Phoenix, AZ 85007 Phone: 1-800-432-4040 Colorado Colorado Department of Public and Environment 4300 Cherry CRK DR South Denver, CO 80246-1530 Phone: 1-800-886-7689 TTY: 1-303-691-7700 Delaware Delaware and Social Herman Holloway Sr. Campus 1901 North Du Pont Highway New Castle, DE 19720 Phone: 1-877-453-0012 TTY: 1-302-391-3505 Guam Division of Senior Citizens Guam 130 University Drive, STE 8, University Castle Mall Mangilao, GU 96913 Phone: 1-671-735-7011 TTY: 1-671-735-7415 Illinois Senior Insurance 1904 Phone: 1-800-224-6330 Connecticut Department of Social Aging Division 55 Farmington AVE, FL 12 Hartford, CT 06105-3730 Phone: 1-860-424-5274 Florida Department of Elder Affairs 4040 Esplanade Way Tallahassee, FL 32399 Phone: 1-800-963-5337 TTY: 1-850-414-2001 Hawaii HAWAII SHIP State Insurance No. 1 Capitol District, 250 South Hotel Street, STE 406 Honolulu, HI 96813-2831 Phone: 1-888-875-9229 TTY: 1-866-810-4379 Indiana State Medicaid Office Indiana Medicaid for Members Sacramento, CA 95834-1992 Phone: 1-800-434-0222 TTY: 1-800-735-2929 DC District of Columbia 899 North Capitol ST NE Washington, DC 20002 Phone: 1-202-442-5955 Georgia DHS Division of Aging - GeorgiaCares Program 2 Peachtree St NW, FL 33 Atlanta, GA 30303 Phone: 1-866-552-4464 Idaho State Medicaid Office and Welfare, Division of Medicaid PO Box 83720 Boise, ID 83720 Phone: 1-866-326-2485 Iowa Senior Insurance

Program One Natural Resources Way, STE 100 Springfield, IL 62702-1271 Phone: 1-800-252-8966 TTY: 1-888-206-1327 Kansas Kansas Department for Aging and Disability New England BLDG 503 S. Kansas AVE Topeka, KS 66603-3404 Phone: 1-800-860-5260 TTY: 1-785-291-3167 402 W Washington ST RM W382 Indianapolis, IN 46204-2739 Phone: 1-800-457-4584 Kentucky Kentucky Cabinet for and Family 275 E Main ST 1E-B Frankfort, KY 40621 Phone: 1-800-372-2973 TTY: 1-800-627-4702 Information Program 601 Locust ST, FL 4 Des Moines, IA 50309-3738 Phone: 1-800-351-4664 TTY: 1-800-735-2942 Louisiana Louisiana Department of Insurance, Senior Insurance Information Program PO Box 94214 Baton Rouge, LA 70804 Phone: 1-800-259-5300 Maine Maine Department of and Human 221 State ST Augusta, ME 04333-0040 Phone: 1-207-287-3707 Massachusetts Executive Office of Elder Affairs One Ashburton Place, RM 517 Boston, MA 02108 Phone: 1-800-243-4636 Mississippi Mississippi State Mariana Islands State Insurance Commissions Office Commonwealth of the N Mariana Islands, Department of Commerce Caller Box 10007 Saipan, MP 96950 Phone: 1-670-664-3000 Michigan Michigan Department of Community Capitol VW BLDG, 201 Townsend ST Lansing, MI 48913 Phone: 1-517-373-3740 TTY: 1-800-649-3777 Missouri Missouri Department of Maryland The Maryland Department of Aging 301 West Preston Street, STE 1007 Baltimore, MD 21201 Phone: 1-800-243-3425 Minnesota Minnesota Board on Aging - Senior LinkAge Line PO Box 64976 St. Paul, MN 55164-0976 Phone: 1-800-882-6262 TTY: 1-800-627-3529 Montana Montana Department of

570 East Woodrow Wilson DR PO Box 1700 Jackson, MS 39215-1700 Phone: 1-866-458-4948 Nebraska Nebraska Senior Insurance Information Program (SHIIP) 941 O ST, STE 400 Lincoln, NE 68508-3690 Phone: 1-800-234-7119 New Jersey State of New Jersey and Senior ; Facilities Division PO Box 367 Trenton, NJ 08625-0367 Phone: 1-800-792-9770 North Carolina North Carolina Department of and Human 2101 Mail Service CTR Raleigh, NC 27699-2101 Phone: 1-919-855-3400 TTY: 1-919-874-2214 and Senior 912 Wildwood PO Box 570 Jefferson City, MO 65102-0570 Phone: 1-800-392-0210 Nevada Nevada Department of and Human 3416 Goni RD STE D- 132 Carson City, NV 89706-2009 Phone: 1-775-687-4210 New Mexico New Mexico Aging & Long-Term (ADRC) PO Box 27118 Santa Fe, NM 87502-7118 Phone: 1-800-432-2080 North Dakota North Dakota Department of 600 E. Boulevard AVE Bismarck, ND 58505-0200 Phone: 1-701-328-2372 Public and Human 111 North Sanders ST PO Box 4210 Helena, MT 59604-4210 Phone: 1-800-551-3191 New Hampshire New Hampshire Department of and Human 129 Pleasant ST Concord, NH 03301-3852 Phone: 1-800-852-3345 TTY: 1-800-735-2964 New York New York State Department of Empire State Plaza, Mailstop: CA/DCS Albany, NY 12237 Phone: 1-800-804-5447 Ohio Ohio 246 North High ST Columbus, OH 43215-2412 Phone: 1-614-466-3543 Oklahoma Oregon Pennsylvania

Oklahoma State 1000 NE 10th Oklahoma City, OK 73117 Phone: 1-800-522-0203 Puerto Rico Puerto Rico Department of / Departmento de Salud PO Box 70184 San Juan, PR 00936-8184 Phone: 1-787-765-2929 South Dakota South Dakota Department of 600 East Capitol AVE Pierre, SD 57501-2536 Phone: 1-800-738-2301 Utah Aging Administrative Office 195 North 1950 West Salt Lake City, UT 84116 Phone: 1-801-538-4171 Virginia Oregon Public Division 800 NE Oregon ST STE 930 Portland, OR 97232 Phone: 1-971-673-1222 TTY: 1-971-673-1222 Rhode Island Rhode Island Department of 3 Capitol Hill Providence, RI 02908 Phone: 1-401-222-5960 Tennessee Tennessee Department of 710 James Robertson PKWY Nashville, TN 37243 Phone: 1-877-287-0010 Vermont Vermont Department of 108 Cherry ST Burlington, VT 05402 Phone: 1-800-464-4343 Washington Pennsylvania Department of & Welfare BLDG, West 625 Forster ST, FL 8 Harrisburg, PA 17120 Phone: 1-877-724-3258 South Carolina South Carolina DHEC Licensing 2600 Bull ST Columbia, SC 29201 Phone: 1-803-545-4370 Texas Texas Department of State PO Box 149347, MC-1913 Austin, TX 78714-9347 Phone: 1-888-963-7111 TTY: 1-800-735-2989 Virgin Islands VI SHIP Medicare Schneider Regional Medical CTR, 9048 Sugar Estate St. Thomas, VI 00802 Phone: 1-340-714-4354 Washington DC

Virginia Department of PO Box 2448 Richmond, VA 23218-2448 Phone: 1-800-955-1819 Washington State HSQA Complaint Intake, PO Box 47857 Olympia, WA 98504-7857 Phone: 1-800-525-0127 District of Columbia 899 North Capitol ST NE Washington, DC 20002 Phone: 1-202-442-5955 West Virginia State Insurance Commissions Office West Virginia Offices of the Insurance Commissioner PO Box 50540 Charleston, WV 25305-0540 Phone: 1-888-879-9842 TTY: 1-800-435-7381 Wisconsin DQA/Bureau of : Complaint Coordinator 819 N 6th ST, RM 609-B Milwaukee, WI 53203 Phone: 1-800-642-6552 TTY: 1-888-701-1253 Wyoming Wyoming Department of 401 Hathaway BLDG Cheyenne, WY 82002 Phone: 1-307-777-7656