MEDICARE MEMBERS: PROTECT YOURSELF AGAINST MEDICARE FRAUD AND IDENTIFY THEFT! THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF INSPECTOR GENERAL IS ALERTING THE PUBLIC ABOUT A FRAUD SCHEME INVOLVING GENETIC TESTING. LEARN HOW TO PROTECT YOURSELF.
Your Rights Upon Disenrollment |
Your Rights Upon Disenrollment
Chapter 10 of your Evidence of Coverage includes information on the member’s and plan’s rights and responsibilities upon disenrollment. Visit the Plan Benefit Materials page to view your plan’s Evidence of Coverage.
We don't want to see you go. Let us improve your experience with our plan. Please call Member Services. We are here to help. If you are still dissatisfied, please fill out and mail the disenrollment form.
- Disenrollment Form English - (PDF) - last updated Oct 17, 2022
- Disenrollment Form Spanish - (PDF) - last updated Nov 9, 2022