A Healthy CollaborationSM

Disenrolling From a Plan

Disenrollment means that you are ending your membership with Community CCRxSM. Disenrollment can be voluntary (your choice) or involuntary (not your own choice).

If you decide you want to disenroll from your current plan, you can do so for any reason between November 15 and December 31 of every year. There are also a few situations where you would be required to leave. For example, you would have to leave Community CCRx if you move out of our geographic service area or if Community CCRx no longer offers prescription drug coverage. We are not allowed to ask you to leave the plan because of your health.

Until your prescription drug coverage with Community CCRx ends, use our network pharmacies to fill your prescriptions.

If you leave Community CCRx, it takes some time for your prescription drug coverage to end and your new prescription drug coverage to begin.

Enrollment is generally for the calendar year. In certain cases, such as if you move or enter an assisted living nursing home, you may be able to disenroll from your plan prior to the end of the year.

After you request to disenroll, Community CCRx will let you know, in writing, the date your coverage ends.

While you are waiting for your membership to end, you are still a member and must continue to get your prescription drugs through Community CCRx’s network pharmacies. In most cases, your prescriptions are covered only if they are filled at a network pharmacy, listed on our formulary and follow other plan rules.

If you don’t receive a letter, call Community CCRx and ask for the date your coverage ended.

If you have any questions about your prescription drug coverage with Community CCRx, please call Member Service at 1-866-684-5353 (TTY 1-866-684-5351), from 8:00 a.m. to 8: p.m.,every day.

What are your options for obtaining prescription drug coverage if you leave Community CCRx?

If you leave Community CCRx, you may obtain prescription drug coverage through another Medicare Prescription Drug Plan. You also have the option of joining a Medicare Advantage Plan with prescription drug coverage, if a plan is available in your area, accepting new members, and you meet the eligibility requirements of the plan.

You may choose to join another Prescription Drug Plan that adds prescription drug benefits to your regular Medicare coverage. To enroll in another Prescription Drug Plan in your area, you must be entitled to Medicare benefits under Part A and/or currently enrolled in Part B and reside in the service area of the Prescription Drug Plan.

You may also be able to get back the prescription drug coverage you had before you enrolled in Community CCRx. Please contact your previous Prescription Drug Plan for more information.

S5803_09P0008_v2 (07/2009) Last Updated: 06/23/2009

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