HealthChoice Medicare Supplement Plans
Disenrollment Information - Ending Your Coverage with HealthChoice

Ending your coverage with HealthChoice can be voluntary (your choice) or involuntary (not your choice). You can choose to leave the Plan or HealthChoice may be required to end your coverage.

When You Decide to End Your Coverage - Voluntary Disenrollment

You have the option to leave the Plan during any Annual Enrollment Period/Option Period; however, in certain situations, you can leave the Plan at other times of the year, known as Special Enrollment Periods. You must submit written notice to OSEEGIB requesting disenrollment, and Medicare then will determine the effective date of your disenrollment.

Be aware that HealthChoice can deny a voluntary request for disenrollment if the request is made outside of an enrollment period.

Medicare Disenrollment Letter and Form

If you are enrolled in a plan with Part D and you drop your HealthChoice coverage, you must enroll in another Part D plan within 63 days to avoid a late enrollment penalty.

Note: As a retiree, if your health, dental, and/or life coverage is cancelled, it cannot be reinstated at a later date unless you return to work as an employee of a participating employer. You forfeit any retirement system contribution paid toward your health insurance premium. Vision coverage is not affected by the cancellation rule and can be elected during the Annual Enrollment Period/Option Period as long as you keep one other benefit through OSEEGIB.

If you drop dependents from your plan, they cannot be re-enrolled unless they lose other group coverage.

When HealthChoice Must End Your Coverage - Involuntary Disenrollment

HealthChoice must end your coverage in the Plan when:

• You fail to pay premiums
• You move out of the United States or its territories for more than 12 months
• You go to prison
• You lie about or withhold information about other prescription coverage you have*
• You continuously behave in a way that is disruptive*
• You allow someone else to use your ID card to purchase prescription drugs

*We cannot end your coverage for these reasons unless we first get permission from Medicare. If HealthChoice ends your coverage, we send you a letter explaining our reasons and include instructions about how you can file a complaint with the Plan.

Note: As a retiree, if your health, dental, and/or life coverage is cancelled, it cannot be reinstated at a later date unless you return to work as an employee of a participating employer. You forfeit any retirement system contribution paid toward your health insurance premium. Vision coverage is not affected by the cancellation rule and can be elected during the Annual Enrollment Period/Option Period as long as you keep one other benefit through OSEEGIB.