Ending Your Membership

Ending your membership in our 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. For example, if you move permanently out of our geographic service area.

Voluntarily Ending Your Membership

In general, there are only certain times during the year when you may voluntarily end your membership in our Plan.

During the Annual Enrollment Period, from October 15 through December 7, anyone with Medicare may switch from one plan to another for the following year. Your change will take effect on January 1.

You have an opportunity to disenroll from our plan and return to Original Medicare during the Medicare Advantage Open Enrollment Period (MAOEP) which takes place January 1 to March 31 or the last day of the 3rd month after your Part A and B entitlement date. The effective date of a disenrollment request made using the MAOEP will be the first of the month following receipt of the disenrollment request. A request made in January will be effective February 1, and a request made in February will be effective March 1. 

Outside of these time periods, you generally can't make other changes during the year unless you meet special exceptions, such as: if you move, if you have Medicaid coverage, or if you gain, lose, or have a change in your dual eligible or Low Income Subsidy status. For more information about these times and the options available to you, please call Member Services 1-888-950-0705 or TTY 711, or refer to the "Medicare & You" handbook you receive each Fall. You may also call 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048, or visit medicare.gov to learn more about your options.

To disenroll from our plan, you can do one of the following:

1. Join a new Medicare Advantage or Prescription Drug Plan. You will be disenrolled automatically from our plan when your new plan's coverage begins.
2. Mail or fax a signed written notice to the plan telling us you want to disenroll.
    

   Mailing address:
   Blue Advantage (PPO)
   450 Riverchase Parkway East
   P.O. Box 13386
   Birmingham, AL 35202-3386
    

   Fax: 1-888-246-0230
    

3. You may download and print the plan's disenrollment notice form and disenrollment checklist or write your own disenrollment request notice.
4. Call Member Services and ask them to send you a disenrollment notice. You will have to complete, sign, and send the notice back to the plan.
5. Call 1-800-MEDICARE (1-800-633-4227).

Your membership in our plan will end on the last day of the month in which your disenrollment request notice is received by the plan.

Until your membership ends, you must keep getting your Medicare services through our Plan or you will have to pay for them yourself.

Until your membership ends, you are still a member of our Plan. During this time, you must continue to get your medical care through our Plan. If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our Plan until you are discharged.

Involuntarily Ending Your Membership

If any of the following situations occur, we must end your membership in our Plan:

• If you move out of the service area or are away from the service area for more than 6 months in a row. If you plan to move or take a long trip, please call Member Services to find out if the place you are moving or traveling to is in our Plan's service area. If you move permanently out of our geographic service area, or if you are away from our service area for more than 6 months in a row, you cannot remain a member of our Plan. In these situations, if you do not leave on your own, we must end your membership ("disenroll" you).
• If you do not stay continuously enrolled in Medicare Part A or Part B (or both).
• If you become incarcerated (go to prison).
• If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
• If you let someone else use your membership card to get medical care.
• 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 care for you and other members of our Plan. We cannot make you leave our Plan for this reason unless we get permission first from Medicare.
• If you do not pay the Plan premiums, we will notify you in writing that you have a 180 day grace period to pay the Plan premium before we end your membership.

We cannot ask you to leave the Plan because of your health.

We cannot ask you to leave your health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave our Plan because of your health, you should call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. You may 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 Plan membership, you will receive an explanation letter that includes details on how to file a complaint.

Patrius Health, a Licensee of the Blue Cross and Blue Shield Association, has a contract with the Centers for Medicare and Medicaid Services (CMS) that is renewed annually, and availability of coverage beyond the end of the current contract year is not guaranteed.