You have rights and responsibilities if you leave Capital Health Plan Retiree Advantage (HMO).
Disenrollment Periods
You may end your membership in our plan only during certain times of the year known as enrollment periods.
If you have questions about enrollment periods please contact your employer or former employer's benefit's department or Capital Health Plan Member Services at the numbers listed on this page.
Medicare Choices upon Disenrollment
If you leave Capital Health Plan Retiree Advantage, you may be eligible to join another Medicare Advantage plan or other Medicare Health Plan. You also can choose Original Medicare. If you choose Original Medicare, you must choose a Prescription Drug Plan if you wish to continue to have Medicare prescription drug coverage.
If you change to Original Medicare you may consider a Medigap policy to supplement your Original Medicare coverage. For Medigap advice, you should contact SHINE (1-800-963-5337/TTY 1-800-955-8771). You also may have a guaranteed issue right if you move out of our service area or if we stop providing Medicare benefits. SHINE can tell you about other situations in which you may have guaranteed issue rights. You will automatically be enrolled in Original Medicare when you leave Capital Health Plan if you do not enroll in another Medicare plan.
Potential for Contract Termination
Capital Health Plan has a contract with the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. All Medicare Advantage Plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage Plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your