How to Disenroll

• 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. CMS determines eligibility for this on a case by case basis
• 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: 711)
• Call 1-800-MEDICARE
• Deliver, mail 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
• We are notified of your passing
• 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