Members

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Disenrollment Rights

Disenrollment from SWH means ending your membership in SWH.

Ending your membership in our plan may be voluntary (your own choice) or involuntary (not your own choice):

  • You might leave SWH 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

In general, there are only certain times during the year when you may voluntarily end your membership in our plan.

Because you qualify for extra help with your prescription drug costs you may enroll in, or disenroll from, SWH at any time for any reason. If you lose this extra help during the year, your opportunity to make a change continues for two months after you are notified that you no longer qualify for extra help.

You Can Choose to Disenroll

To request disenrollment, call SWH’s Member Services department at 1-866-211-1777 or your county Department of Social Services for help and to get the right forms. Fill out the form and return it by mail to SWH or in person to the County Department of Social Services. It could take up to six weeks to process, depending on when your request is received. You can ask for a faster disenrollment if you believe that a delay could harm your health. You can also ask for faster action if you leave our Medicare plan or believe that you were enrolled in this program without your permission. Just call SWH or your local Department of Social Services.

You may disenroll to regular Medicaid or join another Medicaid Advantage plan as long as you also join that plan for your Medicare coverage.

You may disenroll to regular Medicaid or join another health plan as long as you qualify.

We are open weekdays, Monday through Friday, from 8 A.M. to 8 P.M., and also on Saturdays and Sundays from October 15th to February 14th.

Until your membership ends, you must keep getting your Medicare services through our plan or you will have to pay for them yourself.

If you leave our plan, it may take some time for your membership to end and your new way of getting Medicare to take effect (we discuss when the change takes effect later in this section). While you are waiting for your membership to end, you are still a member and must continue to get your care as usual through our plan.

Prior to disenrollment from SWH, it is important that you secure a Medicare Part D Prescription Drug plan. You may contact 1-800-MEDICARE to select a plan or you may call SWH Member Services for assistance at 1-888-794-7268.

If you must get services from plan providers and doctors or other medical providers who are not plan providers before your membership in our plan ends, neither we nor the Medicare program will pay for these services, with just a few exceptions. The exceptions are urgently needed care, care for a medical emergency, and care that has been approved by us. There is another possible exception; if you happen to be hospitalized on the day your membership ends. If this happens to you, call Member Services to find out if your hospital care will be covered by our plan. If you have any questions about leaving our plan, please call us at Member Services.

We cannot ask you to leave our health plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave SWH because of your health, you should call 1-800-MEDICARE (1-800-633-4227), which is the national Medicare help line. TTY users should call 1-877-486-2048. You may call 24-hours-a-day, 7-days-a-week.

Involuntarily ending your membership

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

  • If you no longer meet the eligibility guidelines for Medicaid as determined by your local Department of Health.
  • If you move out of the service area or are away from the service area for more than 6 months in a row. If you plan to move or take a long trip, please call Member Services at 1-866-211-1777 to find out if the place you are moving to or traveling to is in our plan’s service area. TTY users should call 711. If you move permanently out of our geographic service area, or if you are away from our service area for more than six months in a row, you cannot remain a member of SWH. In these situations, if you do not leave on your own, we must end your membership ("disenroll" you).
  • If you do not stay continuously enrolled in "Medicare A and B"; PDP use "Medicare A or B" (or both).
  • If you give us information on your enrollment request that you know is false or deliberately misleading, and it affects whether or not you can 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, CMS may refer your case to the Inspector General for additional investigation.

We are open weekdays, Monday through Friday, from 8 A.M. to 8 P.M., and also on Saturdays and Sundays from October 15th to February 14th.

  • 1-866-211-1777 (toll-free)
  • 711 (TTY)

* Please note: By clicking on this link you will be leaving the SWH web site.

Last modified: 12/22/2011