PPO II - EmblemHealth

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2013 Evidence of Coverage for PPO II Chapter 10: Ending your membership in the plan Th e table below explains how you should end your membership in our plan. If you would like to switch from our plan to: This is what you should do: • Another Medicare health plan. • Original Medicare with a separate Medicare prescription drug plan. Original Medicare without a separate Medicare prescription drug plan. • Note: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. See Chapter 6, Section 10 for more information about the late enrollment penalty. • Enroll in the new Medicare health plan. You will automatically be disenrolled from our plan when your new plan’s coverage begins. • Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled from our plan when your new plan’s coverage begins. • Send us a written request to disenroll. Contact Customer Service if you need more information on how to do this (phone numbers are printed on the back cover of this booklet). • You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and ask to be disenrolled. TTY users should call 1-877-486-2048. • You will be disenrolled from our plan when your coverage in Original Medicare begins. 201
202 2013 Evidence of Coverage for PPO II Chapter 10: Ending your membership in the plan SECTION 4 UNTIL YOUR MEMBERSHIP ENDS, YOU MUST KEEP GETTING YOUR MEDICAL SERVICES AND DRUGS THROUGH OUR PLAN Section 4.1 Until your membership ends, you are still a member of our plan If you leave our plan, it may take time before your membership ends and your new Medicare coverage goes into eff ect. (See Section 2 for information on when your new coverage begins.) 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 fi lled until your membership in our plan ends. Usually, your prescription drugs are only covered if they are fi lled 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). SECTION 5 WE MUST END YOUR MEMBERSHIP IN THE PLAN IN CERTAIN SITUATIONS Section 5.1 When must we end your membership in the plan? We 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 fi nd out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Customer Service are printed on the back cover of this booklet.) • 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 aff ects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare fi rst.) • If you continuously behave in a way that is disruptive and makes it diffi cult 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 fi rst.)
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PPO II - EmblemHealth

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