Member Disenrollment

Member Rights and Responsibilities Upon Disenrollment

How can you end your membership in our Plan?

Medicare allows you to end your membership by doing the following:

  • Make a request in writing to Vitality Health Plan. Or we can send a disenrollment form to you, if you prefer. Call Member Services at 1-866-333-3530; TTY users dial 711 for more information about disenrollment / ending your membership with Vitality Health Plan
  • Contact Medicare at 1-800-MEDICARE (1-800-633-4227); TTY users call 1-877-486-2048
  • Enroll in another Medicare plan during an enrollment period
  • It’s important that you remember to enroll in another Part D plan, so you do not lose your drug coverage when you disenroll from Vitality Health Plan.

It may take time before your membership ends and your new Medicare coverage goes into effect. During this time, you must continue to get your medical care and prescription drugs through our plan.

  • You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends. Usually, your prescription drugs are only covered 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 plan until you are discharged (even if you are discharged after your new health coverage begins).
  • In addition, you may want to tell your doctor that there may be a short delay in updating your records, if you have recently disenrolled from Vitality Health Plan.
  • We will send you a written notice to confirm your disenrollment request once you enroll in another prescription drug plan, or upon receipt of your written request for disenrollment from our plan.

Finally, if your Vitality Health Plan premium is being deducted from your Social Security benefit, please allow up to 3 months for us to process a refund. If you have not received a refund from Social Security within 3 months of this letter, you should contact 1-800-MEDICARE to ask about the refund.

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can file a grievance or make a complaint about our decision to end your membership. Call Member Services or see your Evidence of Coverage for more information about ending your membership in Vitality Health Plan.

Vitality Health Plan of California is an HMO with a Medicare contract. Enrollment in Vitality Health Plan depends on contract renewal. You must continue to pay your Medicare Part B premium. Members may enroll in the plan only during specific times of the year.

Premiums, co-pays, co-insurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. Benefits, premiums, copayments and/or coinsurance may change on January 1 of each year.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Limitations, copayments and restrictions may apply. This information is not a complete description of benefits. Contact the plan for more information.

Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.

ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-866-333-3530. Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to February 14. From February 15 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day. (TTY: 711).

For more information about interpreter services in other languages, click here: https://www.vitalityhp.net/documents/member-information/Language-Availability_English_508.pdf

Last updated 10/14/2019