How to disenroll
You can end your membership in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) at any time.
Your membership will end on the last day of the month that we get your request to change your plan. For example, if we get your request on January 18, your coverage with our plan will end on January 31. Your new coverage will begin the first day of the next month (February 1, in this example).
When you end your membership in our plan, you will continue to be enrolled in Santa Clara Family Health Plan (SCFHP) for your Medi-Cal services, unless you choose a different Cal MediConnect plan or a different Medi-Cal only plan. You can also choose your Medicare enrollment options when you end your membership in our plan. If you leave our plan, you can get information about your Medicare options and Medi-Cal services in Chapter 10, Section D of the SCFHP Cal MediConnect Member Handbook. Find a copy of the Member Handbook in Member Materials.
NOTE: If you're in a drug management program, you may not be able to change plans. See Chapter 5, Section G of the SCFHP Cal MediConnect Member Handbook for more information about drug management programs.
If you decide to end your membership, tell Health Care Options or Medicare that you want to leave SCFHP Cal MediConnect:
- Call Health Care Options at 1-844-580-7272, Monday through Friday from 8 a.m. to 6 p.m. TTY users should call 1-800-430-7077; OR
- Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. When you call 1-800-MEDICARE, you can also enroll in another Medicare health or drug plan. For more information on getting your Medicare services when you leave our plan, see Chapter 10, Section D1 of the SCFHP Cal MediConnect Member Handbook.
Getting medical services and drugs when you are leaving our plan
Until your membership ends in our Cal MediConnect plan, you will keep getting your medical services and drugs through our plan. If you leave SCFHP Cal MediConnect, it may take time before your membership ends and your new Medicare and Medi-Cal coverage begins. During this time, you will keep getting your health care and drugs through our plan.
- You should use our network pharmacies to get your prescriptions filled. Usually, your prescription drugs are covered only if they are filled at a network pharmacy including through our mail-order pharmacy services.
- If you are hospitalized on the day that your membership ends, your hospital stay will usually be covered by our Cal MediConnect plan until you are discharged. This will happen even if your new health coverage begins before you are discharged.
Your membership in our Cal MediConnect plan will end in certain situations
These are the cases when SCFHP Cal MediConnect must end your membership in the plan:
- If there is a break in your Medicare Part A and Part B coverage.
- If you no longer qualify for Medi-Cal. Our plan is for people who qualify for both Medicare and Medi-Cal. To be a member of SCFHP Cal MediConnect, you must keep your eligibility with Medi-Cal and Medicare. The State or Medicare may disenroll you if you are determined no longer eligible for Cal MediConnect.
- If you move out of our service area.
- If you are away from our service area for more than six months.
- If you move or take a long trip, you need to call Customer Service to find out if the place you are moving or traveling to is in our plan’s service area.
- If you go to jail or prison for a criminal offense.
- If you lie about or withhold information about other insurance you have for prescription drugs.
- If you are not a United States citizen or are not lawfully present in the United States.
You must be a United States citizen or lawfully present in the United States to be a member of our plan. The Centers for Medicare & Medicaid Services will notify us if you are not eligible to remain a member on this basis. We must disenroll you if you do not meet this requirement.
If you no longer qualify for Medi-Cal or your circumstances have changed that make you no longer eligible for Cal MediConnect, you may continue to get your benefits from SCFHP for an additional two-month period. This additional time will allow you to correct your eligibility information if you believe that you are still eligible. You will get a letter from us about the change in your eligibility with instructions to correct your eligibility information.
- To stay a member of SCFHP Cal MediConnect, you must qualify again by the last day of the two-month period.
- If you don’t qualify by the end of the two-month period, you’ll be disenrolled from SCFHP Cal MediConnect.
We can make you leave our plan for the following reasons only if we get permission from Medicare and Medi-Cal first:
- If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for 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 member ID card to get medical care.
- If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
We cannot ask you to leave our Cal MediConnect plan for any reason related to your health
If you feel that you are being asked to leave our plan for a health-related reason, you should call Medicare at 1-800 MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.
You have the right to make a complaint if we end your membership in our plan
If we end your membership in our Cal MediConnect plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can make a complaint about our decision to end your membership. For more information on how to make a complaint, see the Complaints, Grievances & Appeals section of our website or see Chapter 9, Section 10 of the SCFHP Cal MediConnect Member Handbook.
Where can you get more information about ending your plan membership?
If you have questions or would like more information on when we can end your membership, you can:
- Call Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
- Call Heath Care Options at 1-844-580-7272, Monday through Friday from 8 a.m. to 6 p.m. TTY users should call 1-800-430-7077.
- Call the California Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222, Monday through Friday, 8 a.m. to 5 p.m. For more information or to find a local HICAP office in your area, please visit http://www.aging.ca.gov/HICAP/.
- Call the Cal MediConnect Ombuds Program at 1-855-501-3077, Monday through Friday from 9 a.m. to 5 p.m. TTY users should call 1-855-847-7914.
- Call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
You can ask for published materials for free in other formats, such as large print, braille, or audio. Call Customer Service for help.
If you speak a language other than English, language assistance services, free of charge, are available to you. Call Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. The call is free.