Rights & Responsibilities Upon Disenrollment

Ending Your Membership with SummaCare

Ending your membership in SummaCare Medicare 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.
• You may 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 (AEP) and during the Medicare Advantage Open Enrollment Period (OEP). In certain situations, you may also be eligible to leave the plan at other times of the year, known as a Special Enrollment Period (SEP).
• The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing.
• There are also limited situations where you do not choose to leave, but we are required to end your membership.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.

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 SummaCare Medicare Customer Service by calling the number on the back of your SummaCare Member ID card if you need more information on how to do this; 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.

Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage for a continuous period of 63 days or more, you may have to pay a Part D late enrollment penalty if you join a Medicare drug plan later. (“Creditable” coverage means the coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.)

SummaCare Medicare must end your membership in the plan if any of the following happen:

• If you no longer have Medicare Part A and Part B.
• If you move out of our service area.
• 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 we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
• If you do not pay the plan premiums for three months.
• We must notify you in writing that you have three months to pay the plan premium before we end your membership.
• 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.