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2013 Evidence of Coverage for PPO II Chapter 10: Ending your membership in the plan SECTION 1 INTRODUCTION Section 1.1 This chapter focuses on ending your membership in our plan Ending your membership in our plan 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. � Th ere are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. Section 2 tells you when you can end your membership in the plan. � Th e process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. Section 3 tells you how to end your membership in each situation. • Th ere are also limited situations where you do not choose to leave, but we are required to end your membership. Section 5 tells you about situations when we must 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. SECTION 2 WHEN CAN YOU END YOUR MEMBERSHIP IN OUR PLAN? 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. Section 2.1 You can end your membership during the Annual Enrollment Period You can end your membership during the Annual Enrollment Period (also known as the “Annual Coordinated Election Period”). Th is is the time when you should review your health and drug coverage and make a decision about your coverage for the upcoming year. • When is the Annual Enrollment Period? Th is happens from October 15 to December 7. • What type of plan can you switch to during the Annual Enrollment Period? 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.) 197
198 2013 Evidence of Coverage for PPO II Chapter 10: Ending your membership in the plan � 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. • When will your membership end? Your membership will end when your new plan’s coverage begins on January 1. Section 2.2 You can end your membership during the annual Medicare Advantage Disenrollment Period, but your choices are more limited You have the opportunity to make one change to your health coverage during the annual Medicare Advantage Disenrollment Period. • When is the annual Medicare Advantage Disenrollment Period? Th is happens every year from January 1 to February 14. • What type of plan can you switch to during the annual Medicare Advantage Disenrollment Period? 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. • When will your membership end? Your membership will end on the fi rst 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 fi rst day of the month after the drug plan gets your enrollment request.
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