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Disenrollment: Your Rights and Responsibilities

For BlueJourney HMO and BlueJourney PPO Members

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Disenrollment is the process to end your membership in our plan. You can disenroll or your membership may be ended involuntarily for specific reasons that are shown below.

You can voluntarily disenroll:

  • If you change plans during the annual enrollment period (October 15 – December 7, for a January 1 effective date).
  • If you qualify for special enrollment periods. Call 800.MEDICARE (800.633.4227), 24 hours a day, 7 days a week. TTY: 711.

If you leave our Plan, it may take time before your membership ends and your new Medicare coverage goes into effect. During that time, you must continue to get your medical care and prescription drugs through our Plan.

Reasons for involuntary disenrollment:

  • If you do not stay continuously enrolled in Medicare Part A and Part B.
  • If you are enrolled in BlueJourney HMO and move out of our service area for more than six months or any time when you confirm a permanent out-of-area address.
  • If you are enrolled in BlueJourney PPO and move out of our service area for more than six months or at any time you confirm a permanent out-of-area address. BlueJourney PPO offers a supplemental visitor/traveler program that allows you to remain enrolled in our plan when you are outside of our service area for less than twelve months. See the BlueJourney PPO Evidence of Coverage for more information.
  • If you become incarcerated (go to prison).
  • If you intentionally give us incorrect information when you are enrolling in our Plan and that information affects your eligibility for our Plan. In this specific instance, we must get permission from Medicare to remove your coverage.
  • If you are continuously disruptive and we are not able to provide medical care to you and other Members in our Plan. In this specific instance, we must get permission from Medicare to remove your coverage.
  • If you let someone else use your membership card to get medical care. In this specific instance, we must get permission from Medicare to remove your coverage.
  • If you do not pay the Plan premiums for two calendar months.
  • If you are required to pay the extra Part D amount because of your income and you do not make the payment, Medicare will disenroll you from our Plan and you will lose prescription drug coverage.

For more information on disenrollment and your rights and responsibilities, please review the BlueJourney PPO Evidence of Coverage or the BlueJourney HMO Evidence of Coverage.

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Updated October 1, 2018

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