DISENROLLMENT

You may choose to disenroll from our Partnership Program for any reason. If you want to disenroll, you must complete and sign a Disenrollment Request Form, which you may obtain from Partnership. Your disenrollment date from the Medicare benefits under the Partnership Program is always the first day of the month following the month in which you sign the Disenrollment Form. Your disenrollment date from the Medicare benefits under the Partnership Program may take up to 45 days after you complete the Disenrollment Form. Please discuss the timing of your disenrollment with your team to ensure that your coverage is not interrupted. Community Health Partnership will notify you of your disenrollment date. If you are eligible for Medicare at disenrollment you may go back to Medicare or other available Medicare options in your area. Even though you have requested disenrollment, you must still get all routine services from our Partnership Program’s contracting medical providers until the effective date of your disenrollment. If you get unauthorized services before your disenrollment, Community Health Partnership or Medicare will not pay for the services except for urgent care, emergency services, and out-of-area dialysis services. You must also pay your monthly cost share through the end of the disenrollment period, whether or not you utilize services during that period of time. Community Health Partnership will send you a letter that confirms when your disenrollment is effective.