Additional Resources

  • Recent policy updates

    June 2019 
    April 2019
    November 2018
    August 2018

    General correspondence address:
    Premera Medicare Advantage Plans
    PO Box 262548
    Plano, TX 75026

    Fax: 800-390-9656

    Disenrollment

    Disenrollment procedure

    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 we are required to end your membership (for example, if you move permanently out of our geographic service area).

    Voluntarily ending your membership

    There are only certain times during the year when you may voluntarily end your membership in our plan. The key time to make changes is the Medicare Fall Open Enrollment Period (also known as the Annual Election Period), which occurs from October 15 through December 7 for enrollments starting January 1 of the following year. This is the time to review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will begin January 1. Certain individuals, such as those with Medicaid, those who get extra help or who move, can make changes at other times. For more information on when you can make changes see the enrollment period table later in this section.

    If you want to end your membership in our plan during this time, this is what you need to do:

    • If you plan to enroll in a new Medicare Advantage plan, join the new plan. You will be disenrolled from our plan when your new plan's coverage begins on January 1.
    • If you plan to switch to the Original Medicare plan and join a Medicare Prescription Drug plan, join the new Medicare Prescription Drug plan. You will be disenrolled from our plan when your new plan's coverage begins on January 1.
    • If you plan to switch to the Original Medicare plan without a Medicare Prescription Drug plan, contact customer service for information on how to request disenrollment. You may also call 800-MEDICARE (800-633-4227) to request disenrollment from our plan. TTY/TTD users should call (TTY/TDD: 711).Your enrollment in Original Medicare will begin January 1.

    If you leave our plan, it may take some time for your membership to end and your new Medicare plan to start. While you are waiting for your membership to end, you are still a member and must continue to get your care and prescription drugs as usual through our plan. If you happen to be hospitalized on the day your membership ends, generally you will be covered by our plan until you are discharged. Call customer service for more information and to help us coordinate with your new plan. Until your prescription drug coverage with our plan ends, use our network pharmacies to fill your prescriptions. While you are waiting for your membership to end, you are still a member and must continue to get your prescription drugs through our plan’s network pharmacies. In most cases, your prescriptions are covered only if they are filled at a network pharmacy, including our mail-order-pharmacy service, are listed on our formulary, and you follow other coverage rules.

    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 800-MEDICARE (800-633-4227), which is the national Medicare help line. TTY/TTD users should call 877-486-2048 (TTY/TDD: 711). You may call 24 hours a day, 7 days a week.

    Involuntary ending of your membership

    If any of the following situations occur, we will end your membership in our plan:

    • If you do not stay continuously enrolled in Medicare A and B
    • If you move out of the service area or are away from the service area for more than six months, we must end your membership disenroll you. If you plan to move or take a long trip, call customer service to find out if the place you are moving to or traveling to is in our plan’s service area.
    • If you knowingly falsify or withhold information about other parties that provide reimbursement for your prescription drug coverage.
    • If you intentionally give us incorrect information on your enrollment request that would affect your eligibility to enroll in our plan.
    • If you behave in a way that is disruptive, to the extent that your continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of our plan. We cannot make you leave our plan for this reason unless we get permission first from Medicare.
    • If you let someone else use your plan membership card to get medical care. If you are disenrolled for this reason, the Centers for Medicare & Medicaid (CMS) may refer your case to the Inspector General for additional investigation.
    • If you do not pay the plan premiums, we will tell you in writing that you have a 60-day grace period during which you may pay the plan premiums before your membership ends.

    You have the right to make a complaint if we end your membership in our plan. We will tell you our reasons in writing and explain how you may file a complaint against us.

    CMS Appointment of Representative Form

    Medicare Complaint Form

    To check on your status or level, call:

    800-MEDICARE (800-633-4227), 24 hours per day, 7 days per week. TTY/TDD users should call 877-486-2048 (TTY/TDD: 711).