Disenrollment

For us, it is a pleasure serving you, and we look forward to having you among our members. However, it is important that you know that as a member of our plan, you have rights and responsibilities upon the option of leaving the plan. You may end your membership in our plan only during certain times of the year, known as Enrollment Periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the Annual Medicare Advantage Disenrollment Period. In certain situations, you may also be eligible to leave the plan at other times during the year. Your disenrollment can be voluntary (your own choice) or involuntary (not your own choice).

 
 

Voluntary Disenrollment 

 

If you want to leave our plan, you must do it in writing.  Please include the reason for which you are requesting the disenrollment.  You can send your request by mail, fax, or deliver it to one of our regional offices.

 

Medicare y Mucho Más
Member Services

PO BOX 71114
SAN JUAN PR 00936-8014
Fax: 787-622-0485

 

PMC Medicare Choice
Member Services

PO Box 366292
San Juan PR 00936-6292
Fax: 787-999-9503

 

First+Plus
Member Services

PO BOX 71114
SAN JUAN PR 00936-8014
Fax: 787-622-0485

 

You can also contact Medicare by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week for more information. TTY users should call 1-877-486-2048.

 

Important: The letter must be signed by the member. In case the member has a legal tutor, it must be indicated in the letter that he/she is the member’s legal tutor and attach the power of attorney.

 

 

Involuntary Disenrollment           

 

Our plan must end your membership in any of the following situations:

 
  • If you lose your entitlement to Medicare Part A and Part B.
  • If you move permanently out of the plan’s service area (the 78 municipalities of Puerto Rico) for six months or more.
  • If you become incarcerated (go to prison).
  • If while enrolled in a Platino (Medicaid) plan, you lose eligibility to Medicaid and you don’t recertify it under a period of six months (6).
  • If you are enrolled in a plan for Chronic Conditions and the condition (s) is not certified.
  • If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
  • If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility in our plan.*
  • If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.*
  • If you let someone else use your membership card to get medical care.*
    • If we end your membership because of this reason, Medicare may request for your case to be investigated by the General Inspector.
  • If, because of your income, you are required to pay an extra amount of Part D and you do not pay, Medicare will disenroll you from our plan and you will lose your prescription drug coverage. 

 

*We cannot make you leave our plan for this reason unless we get permission from Medicare first.

 

 

Voluntary Cancellation

 

The member can request a cancellation from the plan by:

 
  • Calling Member Services or sending a letter by fax or mail:
     

    MMM
    Member Services:

    787-620-2397 (Metro Area)
    1-866-333-5470 (Toll Free)
    1-866-333-5469 TTY (Hearing Impaired)

     

    PMC
    Member Services:

    787-625-2126 (Metro Area)
    1-866-516-7700 (Toll Free)
    1-866-516-7701 TTY (Hearing Impaired)

     

    First+Plus
    Member Services:

    787-522-7800 (Metro Area)
    1-888-767-7717 (Toll Free)
    1-877-672-4242 TTY (Hearing Impaired)

     

    Monday through Sunday, from 8:00 a.m. to 8:00 p.m.

     

    Medicare y Mucho Más
    Member Services

    PO BOX 71114
    SAN JUAN PR 00936-8014
    Fax: 787-622-0485

     

    PMC
    Member Services

    PO Box 366292
    San Juan PR 00936-6292
    Fax: 787-999-9503

     

    First+Plus
    Member Services

    PO BOX 71114
    SAN JUAN PR 00936-8014
    Fax: 787-622-0485

     
  • Visiting our Regional Offices
  • Medicare: by calling 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week for more information. TTY users should call 1-877-486-2048.

 

Important: The letter must be signed by the member. In case the member has a legal tutor, it must be indicated in the letter that he/she is the member’s legal tutor and attach the power of attorney. 

 

 
Additional Information
 
 
  • If you decide to switch to Original Medicare, you might have a special temporary right to buy a Medigap policy, also known as Medicare supplement insurance, even if you have health problems. For example, if you are age 65 or older and you enrolled in Medicare Part B within the past 6 months or if you move out of the service area, you may have this special right. Federal law requires the protections described above. Puerto Rico may have laws that provide more Medigap protections. If you have questions about Medigap or any special temporary rights you may have, you should contact the Puerto Rico Health Insurance Assistance Program, also called the Office for the Ombudsman for Retirees and the Elderly at 1-877-725-4300 or 787-721-6121.  You can also call 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week for more information. TTY users should call 1-877-486-2048.

  • If you were enrolled in another Medicare Advantage or Medicare Prescription Drug Plan and then you enrolled with our plan you may appear on their records as being disenrolled. If your intent is to remain a member of the previous plan:

    • You will need to cancel your enrollment with us, before your membership in our plan becomes effective.

    • You will need to notify them that you enrolled in our plan but have cancelled your enrollment. They may request a letter from our plan for their records.

    Please note that if you do not obtain a Medicare Prescription Drug Coverage or other creditable prescription drug coverage when you become eligible, or if you stay without creditable prescription drug coverage for 63 consecutive days or more, you may have to pay a late enrollment penalty if you enroll in Medicare Prescription Drug Coverage in the future.

  • If you feel that you are being asked to leave our plan because of a health-related reason, you have the right to file a complaint with Medicare.
  • If we end your membership in our plan and you do not agree with our decision, you have the right to file a complaint with us.
  • If you disenroll, remember the following during the disenrollment process.
    • Until your membership ends, you must continue getting your medical services and/or drugs through our plan. That means you can’t disenroll on a Monday and expect to be on a new plan on Tuesday. You must continue to get your medical care and/or prescription drugs through our plan until the end of the month, when the disenrollment is effective.
    • If your plan includes prescription drug coverage, you should continue to use our network pharmacies to get your prescription drugs filled until your membership in our plan ends.
    • 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 (even if you are discharged after your new health coverage begins)
 

For more information on the disenrollment process, please refer to your plan’s Evidence of Coverage (under “Ending your membership in the plan”), call Member Services, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week for more information. TTY users should call 1-877-486-2048.

 

 

 

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