Disenrollment

Disenrollment

What is Disenrollment?

"Disenrollment" means ending your membership in a Cigna-HealthSpring plan. Disenrollment can be voluntary (your own choice) or involuntary (not your own choice).

Some examples:

  • You can disenroll from Cigna-HealthSpring from October 15th through December 7th. You may be able to disenroll at other times of the year, if you meet certain exceptions such as moving out of the Cigna-HealthSpring service area, or if you qualify for Extra Help with prescription drugs.
  • There are also a few situations where you would be required to leave the Plan, including if you move out of a Cigna-HealthSpring geographic service area, or if Cigna-HealthSpring leaves the Medicare program.
  • Under most circumstances, we are not allowed to ask you to leave the plan because of your health. However, there are rare circumstances (such as End-Stage Renal Disease verifications) that may require us to cancel an enrollment.

Whether leaving the plan is your choice or not, this section explains your Medicare prescription drug coverage choices after you leave and the rules that apply. Until your membership officially ends, you must retain your Medicare prescription drug services through your Cigna-HealthSpring plan, or you will have to pay for them yourself

If you have any questions about how or when to disenroll or change your Cigna-HealthSpring plan, please contact us.

Voluntary Disenrollment

You may disenroll from a Cigna-HealthSpring plan only during a Special Enrollment Period (SEP), during the Annual Coordinated Election Period (AEP), which occurs from October 15th through December 7th, or during Annual Disenrollment Period from January 1st through February 14th.

SEPs include those situations where:

  • You have made a change in residence outside the service area.
  • You are entitled to Medicare Part A and Part B and you receive any type of assistance from Medicaid.
  • You receive Extra Help with your medicare prescription drug costs.
  • Cigna-Healthspring violates its contract with you.
  • You receive care in an institution, such as a nursing home or long-term care facility.
  • You were not adequately informed of the creditable status of drug coverage provided by an entity required to give such notice, or a loss of creditable coverage.
  • If you enroll in the Program of All-inclusive Care for Ederly (PACE)
  • You meet such other exceptional conditions as CMS may provide.

During an SEP, you may discontinue enrollment in a Prescription Drug Plan (PDP) offered by a PDP sponsor or change to a different Part D plan. If you disenroll from (or are disenrolled from) a Cigna-HealthSpring Part D plan, you may subsequently enroll in a new Part D plan within the SEP time period. Once you have enrolled in a new Part D plan, the SEP ends for you even if the time frame for the SEP is still in effect.

You may disenroll by:

  • Mailing or faxing a signed written notice to Cigna-HealthSpring, (or through Cigna-HealthSpring’s employer group/union sponsor?, where applicable).
  • Calling 1.800.MEDICARE 24 hours a day/7 days a week. TTY/TDD users call 1.877.486.2048 24 hours a day/7 days a week.
  • Enrolling in another prescription drug plan (during a valid enrollment period)
  • Your disenrollment request must be signed and dated in order for us to process your disenrollment request.

We will then send you a letter that tells you when your membership will end. This is your disenrollment date, which is the day you officially leave Cigna-HealthSpring.

It may take time before your membership ends and your new Medicare coverage goes into effect. While you are waiting for your membership to end, you are still a member of the Cigna-HealthSpring plan. You should continue to use Cigna-HealthSpring benefits until your membership ends.

If you want to talk to someone who can help you decide if this is right for you, call your State Health Insurance Assistance Program.

What are your choices for continuing Medicare Prescription Drug Coverage if you leave a Cigna-HealthSpring plan?

If you leave a Cigna-HealthSpring plan you may have the choice of joining another Medicare Prescription Drug Plan or in a Medicare Health Plan (such as a Medicare HMO or PPO) with prescription drug coverage if any of these types of plans are available in your area and they are accepting new members. Cigna-Healthspring offers many plan options depending upon your need. You may review your options by using our ZIP code search which will show you the plans available in your area.

Please Note: You may not enroll in a new plan during other times of the year unless you meet certain special exceptions, such as if you move out of Cigna-HealthSpring’s service area, want to join a plan in your area with a 5-star rating, or you qualify for extra help with your prescription drug costs.

When can you change your Medicare Prescription Drug choices?

Medicare limits when you can make changes to your coverage. You may only make changes to your Medicare Prescription Drug Plan during a valid enrollment period as outlined below:

  • The Initial Enrollment Period for Part D - The initial enrollment period (IEP) is the period during which an individual is first eligible to enroll in a Part D plan. During this period, individuals may only enroll in a prescription drug plan.
  • The Annual Enrollment Period - The Annual Enrollment Period occurs from October 15th through December 7th. During this period, individuals may enroll, disenroll or choose another prescription drug plan.
  • Special Enrollment Periods - Individuals must meet special exceptions such as if you move out of the Cigna-HealthSpring service area or if you qualify for Extra Help with your prescription drug costs.

Please call our Customer Service department (See Contact Us for details) to see if you qualify for a Special Enrollment Period.

Each individual has one election per enrollment period; once an enrollment or disenrollment becomes effective, the election has been used. After you request a switch, your plan will let you know, in writing, the date your coverage ends. If you don't get a letter, call the plan and ask for the date.

In most cases, your disenrollment date will be the first day of the month that comes after the month we receive your request to leave. For example, if we receive your request to leave during the month of February, your disenrollment date will be March 1st. There is an exception: if we receive your request between October 15th and December 7th, the change will take effect on January 1 of the following year, unless you specifically ask for a disenrollment date of November 1st or December 1st.

What happens to you if Cigna-HealthSpring leaves the Medicare program or Cigna-HealthSpring leaves the area where you live?

All Medicare Prescription Drug Plans agree to stay in the program for a full year at a time. Each year, the plan decides whether to continue for another year.

If we leave the Medicare program or change our service area so that it no longer includes the area where you live, we will give you written notice of the effective date of termination and include a description of alternatives for obtaining benefits under the Medicare program.

All of the benefits and rules described in the Evidence of Coverage will continue until your membership ends. While you are waiting for your membership to end, you are still a member of the Cigna-HealthSpring plan and must continue to get your prescription drugs through Cigna-HealthSpring. You should continue to use Cigna-HealthSpring network pharmacies to get your prescription drugs filled until your membership in our plan ends. Usually your prescription drugs are only covered if they are filled at a network pharmacy.

Cigna HealthCare of Arizona and Connecticut General Life Insurance Company (CGLIC) have contracts with the Centers for Medicare & Medicaid Services (CMS), the government agency that administers the Medicare Program. These contracts renew each year. At the end of each year, the contract is reviewed, and Cigna HealthCare of Arizona, CGLIC, or CMS can decide to end it. You will get 90 days advance notice in this situation. It is also possible for our contract to end at some other time, too. If the contract is going to end, we will generally tell you 90 days in advance. Your advance notice may be as little as 30 days, or even fewer days, if CMS must end our contract in the middle of the year.

Cigna HealthCare of Arizona has contracted with CMS since 1986 and CGLIC has contracted with CMS since 2006.

Under certain conditions Cigna-HealthSpring can end your membership and make you leave the plan

We cannot ask you to leave the plan because of your health. No member of any Medicare Prescription Drug Plan can be asked to leave the plan for any health-related reasons. If you ever feel that you are being encouraged or asked to leave a Cigna-HealthSpring plan because of your health, you should call 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.

We can ask you to leave the plan under certain special conditions. If any of the following situations occur, we must end your membership in a Cigna-HealthSpring plan.

  • If you are enrolled in PDP plan and you move out of our geographic or live outside the plan’s service area for more than twelve months at a time.
  • If you are enrolled in a MAPD plan and you move out of our geographic or live outside the plan’s service area for more than 6 months at a time.
  • If you are incarcerated.
  • If you do not stay continuously enrolled in Medicare Part A or Medicare Part B (or both).
  • 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 obtain prescription drugs through altered or falsified prescriptions. Altered or falsified prescriptions are considered a felony in the State of Arizona and other states. Submission of altered or falsified prescriptions to Cigna-HealthSpring will result in Cigna HealthCare contacting local law enforcement. Cigna HealthCare will prosecute to the fullest extent of the law and submit an Involuntary Disenrollment request to CMS. If you have a question or concern regarding a prescribed medication, please address your concerns with the prescribing provider. 
  • If you let someone else use your membership card to get prescription drugs. 
    • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
  • If you fail to pay your monthly Cigna-HealthSpring plan premium. We will notify you in writing prior to ending your Cigna-HealthSpring coverage.

If you are enrolled in a Special Needs Plan, and lose your eligibility for that Plan.

You have the right to make a complaint if we ask you to leave a Cigna-HealthSpring 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.

Please reference your Evidence of Coverage for more information about this process and your options.