Disenrollment Rights and Responsibilities

The resource information pertaining to ending your membership with Senior Health Plan is taken from the 2017 Evidence of Coverage (EOC). For members enrolled in the Silver plan, see Chapter 8, Ending your membership in the plan. For members enrolled in Silver Plus, Platinum or Platinum Plus, see Chapter 10, Ending your membership in the plan. To print a copy of the EOC, please click on the link.

In certain situations, you can end your membership during a Special Enrollment Period

In certain situations, members of Senior Health Plan (HMO) may be eligible to end their membership at other times of the year. This is known as a Special Enrollment Period.

  • Who is eligible for a Special Enrollment Period? If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period. These are just examples, for the full list you can contact us at 1-800-642-8065(Monday – Friday from 8:00 am to 8:00 pm, CST). TTY/TDD users should call 1-800-722-0353. Or call Medicare or visit the Medicare website (https://www.medicare.gov):

    • Usually, when you have moved.
    • If you have SoonerCare.
    • If you enrolled in a plan with prescription drug coverage and are eligible for "Extra Help" with paying for your Medicare prescriptions.
    • If we violate our contract with you.
    • If you are getting care in an institution, such as a nursing home or long-term care (LTC) hospital.
  • When are Special Enrollment Periods? The enrollment periods vary depending on your situation.

  • What can you do? To find out if you are eligible for a Special Enrollment Period, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048. 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 any of the following types of plans:

    • Another Medicare health plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
    • Original Medicare with a separate Medicare prescription drug plan.
    • – or – Original Medicare without a separate Medicare prescription drug plan.
  • If you are enrolled in a plan with prescription drug coverage and receive "Extra Help" from Medicare to pay for your prescription drugs: If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment.

      Note: If you disenroll from Medicare prescription drug coverage and go without creditable prescription drug coverage, you may need to pay a 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.) See your Evidence of Coverage for more information about the late enrollment penalty.

  • When will your membership end? Your membership will usually end on the first day of the month after your request to change your plan is received.

Disclaimers

  • You may join or leave a plan only at certain times. Please call Senior Health Plan at the telephone number listed in the previous section of this web page or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048. You can call this number 24 hours a day, seven days a week.
  • You can join Senior Health Plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Senior Health Plan unless they are members of our organization and have been since their dialysis began.
  • Senior Health Plan has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or search the Senior Health Plan provider directory on this website. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither Senior Health Plan nor Original Medicare will pay for these services.
  • You must continue to pay your Medicare Part B premium, even if the Senior Health Plan premium is $0.