Your Rights and Responsibilities for Leaving the Plan

You can leave KelseyCare Advantage in two ways:

• Voluntarily (you choose to leave)
• Involuntarily (you are removed from the plan)

You may decide to leave if the plan no longer meets your needs. However, you can only leave at certain times of the year or in special situations.

The steps to leave depend on what type of new coverage you choose. If you decide to leave, you must keep using our plan for your care until your membership officially ends.

In some cases, you may be removed from the plan even if you do not choose to leave. These situations are limited and follow specific rules.

When Can You End Your Membership in Our Plan?

You can leave the plan at certain times during the year. These are called enrollment periods.

Annual Enrollment Period (October 15 – December 7)

This is when you should review your health and drug coverage and decide if you want to make a change.

• If you join a new plan during this time, your new coverage will begin on January 1
• Your membership in our plan will end when your new plan starts

Medicare Advantage Open Enrollment Period (January 1 – March 31)

During this time, you can make one change to your health coverage.

• You can switch to another Medicare Advantage plan, or
• You can leave our plan and return to Original Medicare
• Your membership will end on the first day of the month after we receive your request

Special Enrollment Periods

In some situations, you may be able to leave the plan at other times of the year. These are called Special Enrollment Periods.

You may qualify if:

• You move to a new area
• You have Medicaid
• You qualify for “Extra Help” with your prescription drug costs
• We do not follow our contract with you
• You live in or move into a nursing home or long-term care facility

To learn if you qualify, 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.

Where Can You Get More Information About When You Can End Your Membership?

If you have questions or want more information, you can:

• Call Member Services for help
• Check the Medicare & You Handbook for details
• Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.

Coverage Until Your Membership Ends

You are still a member of our plan until your membership officially ends.

If you leave KelseyCare Advantage, there may be a short time before your membership ends and your new Medicare coverage begins. During this time:

• You must continue to get your medical care and prescription drugs through our plan
• You should keep using our network pharmacies to fill your prescriptions
  • In most cases, your drugs are only covered if you use a network pharmacy
• If you are in the hospital on the day your membership ends, your stay is usually covered
  • This means your hospital care will continue to be covered until you are discharged, even if your new coverage has already started

When We Must End Your Membership

In some situations, KelseyCare Advantage is required to end your membership in the plan.

We must end your membership if any of the following happen:

• You are no longer enrolled in Medicare Part A and Part B.
• You move outside of our service area
• You are out of our service area for more than 6 months
  • If you plan to move or travel, call Member Services to see if your new location is in our service area
• You are incarcerated (in prison)
• You do not tell the truth or leave out important information about other prescription drug coverage you have
• You give incorrect information on purpose when enrolling, and it affects your eligibility (Medicare must approve this action first)
• You repeatedly act in a way that disrupts care for you or others (Medicare must approve this action first)
• You let someone else use your member ID card to get care (Medicare must approve this action first)
  • If this happens, Medicare may review your case
• You do not pay your monthly plan premium for two months (if your plan has a premium)
  • We will send you a written notice and give you time to pay before ending your membership
• You are required to pay an extra Part D premium (based on income) and do not pay it
  • Medicare will remove you from the plan and you will lose prescription drug coverage

Where Can You Get More Information?

If you have questions or want more information about when we can end your membership:

• Call Member Services for help
• You can find the phone number on the Contact Us page.

We Cannot End Your Membership for Health Reasons

KelseyCare Advantage cannot ask you to leave the plan for any reason related to your health.

• If you think you are being asked to leave for a health-related reason, you should call 1-800-MEDICARE (1-800-633-4227).
• TTY users can call 1-877-486-2048.
• You can call 24 hours a day, 7 days a week.

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 provide a written notice explaining the reason for the termination and information about your right to file a complaint or appeal our decision.