How can I disenroll?
Medicare will only allow you to disenroll at certain times during the year. After we receive your disenrollment form, EnvisionRx Plus will let you know if you can disenroll at this time. If you can disenroll, we will also tell you the effective date of your disenrollment.
Generally, you may not enroll in a new plan during other times of the year unless you meet certain special exceptions, such as if you move out of EnvisionRx Plus’s service area. From November 15 through December 31 each year, you can enroll in a new Medicare Prescription Drug Plan or Medicare Health Plan for the following year.
If you qualify for extra help with your prescription drug costs you may enroll in, or disenroll from, a plan at any time. If you lose this extra help during the year, your opportunity to make a change continues for two months after you are notified that you no longer qualify for extra help.
You may submit a disenrollment request in one of two ways:
- Complete the Disenrollment Form and send it to the following:
EnvisionRx Plus
Attn: Enrollment/Disenrollment
Dept P.O. Box 1298
Twinsburg OH, 44087
Fax: 1-866-250-5178
- Complete the Online Disenrollment Request.
Submitting your Disenrollment Request
You should not submit a disenrollment request if you are planning to enroll, or have enrolled, in another Medicare prescription drug plan or Medicare Advantage-Prescription Drug plan. Enrolling in a prescription drug plan or a Medicare Advantage-Prescription Drug plan will automatically disenroll you from EnvisionRx Plus. You should submit a disenrollment request only if you no longer want Medicare prescription drug coverage and want to disenroll from this coverage completely.
Information about your disenrollment request
Until your disenrollment date, you should keep using EnvisionRx Plus network pharmacies to fill your prescriptions. If you use an out-of-network pharmacy and there is not an emergency,EnvisionRx Plus may not pay for your prescriptions. After your disenrollment date, EnvisionRx Plus will not cover any prescription drugs you receive.
By disenrolling from EnvisionRx Plus, you are disenrolling from your Medicare prescription drug coverage. If you do not enroll in another Medicare Prescription Drug Plan (or a Medicare Advantage Plan with prescription drug coverage) at this time or you do not have or obtain creditable prescription drug coverage (as good as Medicare’s), you may have to pay a late enrollment penalty in addition to your premium for Medicare prescription drug coverage in the future. For information about the Medicare Plans available in your area, call Medicare at 1-800- MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY/TDD users should call 1-877-486-2048.
Can I be disenrolled involuntarily?
You may be involuntarily disenrolled from a Plan in special circumstances. These special circumstances include the following:
- Change in Residence
- Loss of Medicare Entitlement
- Death
- PDP contract terminated or PDP discontinues or reduces service area so that an individual no longer resides in the plan service area.
- Incarceration
- Failure to pay premiums
- Misrepresentation regarding coverage from member
- Disruptive member behavior
We cannot ask you to leave our plan because of your heath.
If you have any questions about disenrollment procedures, please call Member Services at 1-866-250-2005, 24 hours a day, 7 days a week (TTY users should call 1-866-763-9630).
|
