Rights and Responsibilities Upon Disenrollment
Ending your membership in IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) 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.
- There are also limited situations where you do not choose to leave, but we are required to end your membership.Chapter 10 of your IEHP DualChoice Member Handbook tells you about situations when we must end your membership.
When can you end your membership in our plan?
- Because you get assistance from Medi-Cal, you can end your membership in IEHP DualChoice at any time.
- Your membership will usually end on the first day of the month after we receive your request to change plans. Your enrollment in your new plan will also begin on this day.
How to voluntarily end your membership in our plan?
- If you would like to switch from our plan to another Medicare Advantage plan simply enroll in the new Medicare Advantage plan. You will be automatically disenrolled from IEHP DualChoice, when your new plan’s coverage begins.
- If you would like to switch from our plan to Original Medicare but you have not selected a separate Medicare prescription drug plan. You must ask to be disenrolled from IEHP DualChoice. There are two ways you can asked to be disenrolled:
- To disenroll, please call Health Care Options (HCO) at 1-844-580-7272, 8am - 5pm (PST), Monday - Friday. TTY/TDD users should call 1-800-430-7077. For more information visit the DHCS website. By clicking on this link, you will be leaving the IEHP DualChoice website.
- 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.
Until your membership ends, you are still a member of our plan.
If you leave IEHP DualChoice, it may take time before your membership ends and your new Medicare coverage goes into effect. (See Chapter 10 of the IEHP DualChoice Member Handbook for information on when your new coverage begins.) During this time, 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. Usually, your prescription drugs are only covered if they are filled at a network pharmacy including through our mail-order pharmacy services.
- If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).
- If you no longer qualify for Medi-Cal or your circumstances have changed that make you no longer eligible for Cal MediConnect, you may continue to get your benefits from IEHP DualChoice for an additional two-month period. This additional time will allow you to correct your eligibility information if you believe that you are still eligible. You will get a letter from us about the change in your eligibility with instructions to correct your eligibility information.
- To stay a member of IEHP DualChoice, you must qualify again by the last day of the two-month period.
- If you do not qualify by the end of the two-month period, you’ll de disenrolled by IEHP DualChoice.
Involuntarily ending your membership
IEHP DualChoice must end your membership in the plan if any of the following happen:
- If you do not stay continuously enrolled in Medicare Part A and Part B.
- If you move out of our service area for more than six months.
- If you move or take a long trip, you need to call IEHP DualChoice Member Services to find out if the place you are moving or traveling to is in our plan’s area.
- If you become incarcerated.
- 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.
- 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 and Medi-Cal first.
- If you let someone else use your membership card to get medical care.
- If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
- To be a Member of IEHP DualChoice, you must keep your eligibility with Medi-Cal and Medicare. If you lose your zero share-of-cost, full scope Medi-Cal, you will be disenrolled from our plan (for your Medicare benefits) the first day of the following month and will be covered by the Original Medicare.
- The State or Medicare may disenroll you if you are determined no longer eligible to the program.
IEHP DualChoice Cal MediConnect Plan (Medicare-Medicaid Plan) is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
Information on this page is current as of October 15, 2018.