Beneficiaries and Plan rights and responsibility upon disenrollment

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.
• There are also limited situations where we are required to end your membership, for example, if you move permanently out of our geographic service area.

There are only certain times during the year when you may voluntarily end your membership in our Plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”) which occurs every year from October 15 through December 7. This is the time to review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1. Certain individuals, such as those with Medicaid, those who qualify for extra help with prescription drug costs or those who move, can make changes at other times.

If you leave our plan it may take some time for your membership to end and your new way of getting Medicare to take effect. While you are waiting for your membership to end, you are still a member of PrimeTime Health Plan and must continue to get your care and prescription drugs as usual through our Plan. If you happen to be hospitalized on the day your membership ends, generally you will be covered by our Plan until you are discharged. Call Customer Service for more information and to help us coordinate with your new plan.

Until your prescription drug coverage with our Plan ends, use our network pharmacies to fill your prescriptions. While you are waiting for your membership to end, you are still a member of PrimeTime Health Plan and must continue to get your prescription drugs as usual through our Plan’s network pharmacies. In most cases, your prescriptions are covered only if they are filled at a network pharmacy (including our mail-order pharmacy service), are listed on our formulary and you follow other coverage rules.