Medicare Health Plans >> Ending your Membership

Medicare Health Plans

Ending your Membership - Rights & Responsibilities

Ending your membership in Welborn Health Plans (WHP) can be voluntary (your own choice) or involuntary (not your own choice):

• You might leave WHP 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.

Voluntarily ending your membership
In general, you can end your membership in either if the WHP plans at any time during the year. Your membership will end on the first of the month following receipt of your request to WHP. Generally, to end your membership, you must make this request in writing to us. Contact us if you need more information on how to do this.

Until your membership ends, you must keep getting your Medicare services through our Plan or you will have to pay for them yourself.
If you leave WHP, 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 and must continue to get your care as usual through our Plan. If you have any questions about
leaving our plan, please call us at Member Services.

We cannot ask you to leave the plan because of your health.
We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave WHP because of your health, you should call 1-800- MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-
486-2048. You can call 24 hours a day, 7 days a week."

Involuntarily ending your membership
If any of the following situations occur, we will end your membership in WHP

• If you move out of the service area or are away from the service area for more than 180 days in a row. If you plan to move or take a long trip, please call Member Services to find out if the place you are moving to or traveling to is in plan’s service area. If you move permanently out of our service area, or if you are away from our service area for more than 180 days in a row in the WHP Senior Advantage or WHP Senior Advantage Plus, you will need to leave (“disenroll” from) WHP. In these situations, if you do not leave on your own, we must end your membership (“disenroll” you).
• If you do not stay continuously enrolled in Medicare Part B.
• If you give us information on your enrollment form that you know is false or deliberately misleading, and it affects whether or not you can enroll in our Plan.
• If you behave in a way that is unruly, uncooperative, disruptive, or abusive, and this behavior seriously affects our ability to arrange or provide medical care for you or for others who are members of our Plan. We cannot make you leave our plan for this reason unless we get permission first from the Centers for Medicare & Medicaid Services, the government agency that runs Medicare.
• If you let someone else use your plan membership card to get medical care. Before we askyou to leave our plan for this reason, we must refer your case to the Inspector General and thismay result in criminal prosecution.
• If you do not pay the basic plan premiums or cost sharing, we will tell you in writing before you are required to leave our Plan.

You have the right to make a complaint if we end your membership in our Plan
If we end your membership in our Plan, we will tell you our reasons in writing and explain how you can file a complaint against us if you want to.

Notice about non-discrimination
We don’t discriminate based on a person’s race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. All organizations that provide Medicare Advantage Plans or Medicare Prescription Drug Plans, like our Plan, must obey federal laws against discrimination, including Title VI of the Civil Rights Act of 1964, the Rehabilitation Act of 1973, the Age Discrimination
Act of 1975, the Americans with Disabilities Act, all other laws that apply to organizations that get Federal funding, and any other laws and rules that apply for any other reason.

Call or write if you have any questions:
Welborn Health Plans
101 SE 3rd St
Evansville, IN 47708
(812) 426-6600
Toll Free: 1-800-521-0265
TTY users may call: Indiana Relay 1-800-743-3333
FAX: (812) 773-0589

 

H3044_H1558_WHPWeb (10/2009)