Rights & Responsibilities Upon Disenrollment

You may voluntarily 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. You may also end your membership during the annual Open Enrollment Period, but your plan choices are more limited. In certain situations, you may also be eligible to leave the plan at other times of the year (Special Enrollment Period).

Annual Enrollment Period (October 15 – December 7)

You may enroll in another Medicare health plan, Original Medicare with a separate Medicare prescription drug plan, or Original Medicare without a separate Medicare prescription drug plan.
Your membership will end when your new plan’s coverage begins on January 1.

Open Enrollment Period (OEP) (January 1 – March 31 of each year)

During this period individuals enrolled in Medicare Advantage (MA) plans as of January 1 may enroll in another MA or Medicare Prescription Drug plan or disenroll and return to Original Medicare. Individuals may make only one election during the MA OEP.

Special Enrollment Period (subject to situation)

If you are eligible to end your membership because of a special situation, you can choose to change both your Medicare health coverage and prescription drug coverage. This means you can choose another Medicare health plan or Original Medicare with a separate Medicare prescription drug plan or Original Medicare without a separate Medicare prescription drug plan. For a list of Special Enrollment Periods, visit Medicare.gov.
Your membership will usually end on the first day of the month after your request to change your plan is received.

Usually, to end your membership in our plan, you simply enroll in another Medicare plan during one of the enrollment periods. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you must ask to be disenrolled from our plan. There are two ways you can ask to be disenrolled:

You can make a request in writing to us. Contact Customer Service if you need more information on how to do this. Customer Service can be reached by phone at 434-947-3671 or toll-free 1-877-210-1719, 8:00 a.m. to 8:00 p.m., seven days a week from October 1 through March 31. From April 1 through September 30, Customer Service is available 8:00 a.m. to 8:00 p.m., Monday through Friday. TTY users should call 711.

-OR-

You can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

Your Rights and Responsibilities Upon Disenrollment

Until your membership ends and your new Medicare coverage goes into effect, 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 filled until your membership in our plan ends.
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.
You have the right to make a complaint if we end your membership in our plan.

Our Rights and Responsibilities Upon Disenrollment

We have the right to disenroll you for the following reasons:

If you no longer have 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 become incarcerated (go to prison).
If you are not a United States citizen or lawfully present in the United States.
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 affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
If you continuously behave in a way that is disruptive and makes it difficult 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 first.)
If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
If you do not pay the plan premiums for two calendar months after the first day the plan premium (including any late enrollment penalty) is due.
If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.

For more information, see Chapter 10, Section 1 of your Evidence of Coverage or CLICK HERE

Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

H1659_Web2019_C
Last update 10/01/2018