Ending your Membership

Enroll in 2010 plans.

This page focuses on ending your membership in our plan

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

You might leave our plan because you have decided that you want to leave.

There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. The information below tells you when you can end your membership in the plan.
The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. The information below tells you how to end your membership in each situation.

There are also limited situations where you do not choose to leave, but we are required to end your membership. The information below tells you about situations when we must end your membership.

If you are leaving our plan, you must continue to get your medical care and prescription drugs through our plan until your membership ends.

When can you end your membership in our 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 Medicare Advantage Open Enrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year.

You can end your membership during the Annual Enrollment Period

You can end your membership during the Annual Enrollment Period (also known as the "Annual Coordinated Election Period"). This is the time when you should review your health and drug coverage and make a decision about your coverage for the upcoming year.

When is the Annual Enrollment Period? This happens every year from November 15 to December 31.
What type of plan can you switch to during the Annual Enrollment Period? During this time, you can review your health coverage and your prescription drug coverage. You can choose to keep your current coverage or make changes to your coverage for the upcoming year. If you decide to change to a new plan, you can choose any of the following types of plans:

Another Medicare Advantage plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
Original Medicare with a separate Medicare prescription drug plan, or;
Original Medicare without a separate Medicare prescription drug plan.

Note: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. ("Creditable" coverage means the coverage is at least as good as Medicare's standard prescription drug coverage.)

When will your membership end? Your membership will end when your new plan's coverage begins on January 1.

You can end your membership during the Medicare Advantage Open Enrollment Period, but your plan choices are more limited

You have the opportunity to make one change to your health coverage during the Medicare Advantage Open Enrollment Period.

When is the Medicare Advantage Open Enrollment Period? This happens every year from January 1 to March 31.
What type of plan can you switch to during the Medicare Advantage Open Enrollment Period?
During this time, you can make one change to your health plan coverage. However, you may not add or drop prescription drug coverage during this time. Since you are currently enrolled in a Medicare Advantage plan with prescription drug coverage, this means that you can enroll in either:

Another Medicare Advantage plan with prescription drug coverage.
Original Medicare and a separate Medicare prescription drug plan.

When will your membership end? Your membership will end on the first day of the month after we get your request to change plans.

In certain situations, you can end your membership during a Special Enrollment Period

In certain situations, members may be eligible to end their membership at other times of the year. This is known as a Special Enrollment Period.

Who is eligible for a Special Enrollment Period? If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period. These are just examples, for the full list you can contact the plan, call Medicare, or visit the Medicare Web site:

Usually, when you have moved.
If you have Medicaid.
If you are eligible for extra help with paying for your Medicare prescriptions.
If you live in a facility, such as a nursing home.

When are Special Enrollment Periods? The enrollment periods vary depending on your situation.
What can you do? If you are eligible to end your membership because of a special situation, you can choose to change both your Medicare health coverage and prescription drug coverage. This means you can choose any of the following types of plans:

Another Medicare Advantage plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
Original Medicare with a separate Medicare prescription drug plan.
Original Medicare without a separate Medicare prescription drug plan.

When will your membership end? Your membership will usually end on the first day of the month after we receive your request to change your plan.

Where can you get more information about when you can end your membership?

If you have any questions or would like more information on when you can end your membership:

You can call Customer Service.
You can find the information in the Medicare & You 2010 handbook.

Everyone with Medicare receives a copy of Medicare & You each fall. Those new to Medicare receive it within a month after first signing up.
You can also download a copy from the Medicare Web site. Or, you can order a printed copy by calling Medicare at the number below.

You can contact 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.

How do you end your membership in our plan?

Usually, you end your membership by enrolling in another plan

Usually, to end your membership in our plan, you simply enroll in another health plan during one of the enrollment periods. One exception is when you want to switch from our plan to Original Medicare without a Medicare prescription drug plan. In this situation, you must call Customer Service and ask to be disenrolled from our plan.

The table below explains how you should end your membership in our plan.

If you would like to switch from our plan to:	This is what you should do:
Another Medicare Advantage plan.	Enroll in the new Medicare Advantage plan. You will automatically be disenrolled when your new plan's coverage begins.
Original Medicare with a separate Medicare prescription drug plan.	Enroll in the new Medicare prescription drug plan. You will automatically be disenrolled when your new plan's coverage begins.
Original Medicare without a separate Medicare prescription drug plan.	Call Customer Service and ask to be disenrolled from the plan. You can also contact Medicare, at 1-800-MEDICARE (1-800-633-4227) and ask to be disenrolled. TTY users should call 1-877-486-2048. You will be disenrolled when your coverage in Original Medicare begins.

Until your membership ends, you must keep getting your medical services and drugs through our plan

Until your membership ends, you are still a member of our plan

If you leave the 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, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).

We must end your membership in the plan in certain situations

When must we end your membership in the plan?

We must end your membership in the plan if any of the following happen:

If you do not stay continuously enrolled in Medicare Part A and Part B.
If you move out of our service area for more than six months. (For Members enrolled in Medicare Plus Blue PPO^SM, the Visitor/Traveler benefit provides you with additional network access in the states and areas specified in Chapter 4, Section 2.3 of the Evidence of Coverage for PPO members for a maximum of 12 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 area.
Your Evidence of Coverage provides more information about getting care when you are away from the service area.

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 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.

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

If you let someone else use your membership card to get medical care.

If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.

If you do not pay the plan premiums for two months.

We must notify you in writing that you have two months to pay the plan premium before we end your membership.

Where can you get more information?

If you have questions or would like more information on when we can end your membership:

You can call Customer Service for more information.

We cannot ask you to leave our plan for any reason related to your health

What should you do if this happens?

If you feel that you are being asked to leave our plan because of 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 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. You can also look in your Evidence of Coverage for information about how to make a complaint.

Medicare Plus Blue PPO^SM and Medicare Plus Blue PFFS^SM are health plans with Medicare contracts. Prescription Blue PDP^SM is a stand-alone prescription drug plan with a Medicare contract.

Important information about these plans

Medicare Plus Blue PPO^SM is available in these counties: Alcona, Alger, Allegan, Alpena, Arenac, Baraga, Barry, Bay, Berrien, Branch, Calhoun, Cass, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ingham, Ionia, Iosco, Iron, Isabella, Jackson, Kalamazoo, Kent, Keweenaw, Lake, Lapeer, Lenawee, Livingston, Luce, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Menominee, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Ontonagon, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, Wexford.

With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower. You may receive services from any provider who accepts your Medicare Plus Blue PPO^SM ID card. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit bcbsm.com/medicare/search.shtml.

Medicare Plus Blue PPO^SM provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.

Medicare Plus Blue PFFS^SM
Medicare Plus Blue PFFS^SM is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and enrolled in Part B.

A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 160K).

Prescription Blue PDP^SM
Prescription Blue PDP^SM is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.

Medicare beneficiaries enrolled in a Medicare Advantage PFFS plan that includes Medicare prescription drugs or any Medicare Advantage coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or Medicare Advantage PFFS plan if they enroll in a prescription drug plan; and Medicare beneficiaries enrolled in a private fee-for-service plan (PFFS) that does not include Medicare prescription drug coverage, a Medicare Advantage Medicare Savings Account (MSA) plan or an 1876 Cost plan may enroll in a prescription drug plan and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.

Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP^SM
Premiums vary by county. You must continue to pay your Medicare Part B premium.

In Michigan, 86 percent of pharmacies are network pharmacies; nationwide, more than 80 percent of pharmacies are in the network, including the majority of chain pharmacies, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies (Source: 2010 Pharmacy Directory). In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Customer Service at 1-877-469-2583, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.

If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact Blue Cross Blue Shield of Michigan for details.

In addition to enrolling through this Web site, Medicare beneficiaries may enroll in Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM or Prescription Blue PDP^SM through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may only enroll in Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM or Prescription Blue PDP^SM during specific times of the year. To learn more about enrollment periods, please contact Customer Service.

This document is available in alternate formats or languages. For more information, call 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.

Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP^SM are issued by Blue Cross Blue Shield of Michigan, which contracts with the federal government. Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP's^SM contracts with CMS are renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

Medicare Plus Blue PPO^SM
Medicare Plus Blue PPO^SM is available to all Medicare beneficiaries who are Michigan residents who reside within the plan's 75-county service area and are entitled to receive services under Medicare Part A and enrolled in Part B.
Medicare Plus Blue PPO^SM is available in these counties: Alcona, Alger, Allegan, Alpena, Arenac, Baraga, Barry, Bay, Berrien, Branch, Calhoun, Cass, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ingham, Ionia, Iosco, Iron, Isabella, Jackson, Kalamazoo, Kent, Keweenaw, Lake, Lapeer, Lenawee, Livingston, Luce, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Menominee, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Ontonagon, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, Wexford.
With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare allowed amount and the contracted amount is lower. You may receive services from any provider who accepts your Medicare Plus Blue PPO^SM ID card. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit bcbsm.com/medicare/search.shtml.
Medicare Plus Blue PPO^SM provides reimbursement for all covered benefits regardless of whether they are received in-network, as long as they are medically necessary.
Medicare Plus Blue PFFS^SM
Medicare Plus Blue PFFS^SM is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and enrolled in Part B.
A Medicare Advantage private fee-for-service plan works differently than a Medicare supplement plan. Your doctor or hospital can continue to treat you if it agrees to accept our terms and conditions of payment, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can find the plan's terms and conditions on our Web site at bcbsm.com/ma. You can also read more about how private fee-for-service plans work for you in our downloadable flyer (PDF 160K).
Prescription Blue PDP^SM
Prescription Blue PDP^SM is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.
Medicare beneficiaries enrolled in a Medicare Advantage PFFS plan that includes Medicare prescription drugs or any Medicare Advantage coordinated care (HMO or PPO) plan will be automatically disenrolled from the HMO, PPO or Medicare Advantage PFFS plan if they enroll in a prescription drug plan; and Medicare beneficiaries enrolled in a private fee-for-service plan (PFFS) that does not include Medicare prescription drug coverage, a Medicare Advantage Medicare Savings Account (MSA) plan or an 1876 Cost plan may enroll in a prescription drug plan and will not be automatically disenrolled from the PFFS, MSA or 1876 Cost plan.
Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP^SM
Premiums vary by county. You must continue to pay your Medicare Part B premium.
In Michigan, 86 percent of pharmacies are network pharmacies; nationwide, more than 80 percent of pharmacies are in the network, including the majority of chain pharmacies, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies (Source: 2010 Pharmacy Directory). In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Customer Service at 1-877-469-2583, 8 a.m. to 8 p.m., seven days a week. TTY users should call 1-800-481-8704. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X435, Detroit, MI 48226.
If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.
The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact Blue Cross Blue Shield of Michigan for details.
In addition to enrolling through this Web site, Medicare beneficiaries may enroll in Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM or Prescription Blue PDP^SM through the Centers for Medicare & Medicaid Services Online Enrollment Center, located at medicare.gov. For more information, please contact Blue Cross Blue Shield of Michigan at 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704. You may only enroll in Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM or Prescription Blue PDP^SM during specific times of the year. To learn more about enrollment periods, please contact Customer Service.
This document is available in alternate formats or languages. For more information, call 1-877-469-2583, 8 a.m. to 8 p.m. seven days a week. TTY users should call 1-800-481-8704.
Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP^SM are issued by Blue Cross Blue Shield of Michigan, which contracts with the federal government. Medicare Plus Blue PPO^SM, Medicare Plus Blue PFFS^SM and Prescription Blue PDP's^SM contracts with CMS are renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day, seven days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
Your State Medicaid Office.

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