California PHP

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 (also known as the “Annual Open Enrollment 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.

The Annual Enrollment Period is from October 15 to December 7. During this time, you can review your health and 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, like PHP, 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.

Your membership will end when your new plan’s coverage begins on January 1.

You have the opportunity to make one change to your health coverage during the Medicare Advantage Open Enrollment Period, which happens every year from January 1 to March 31. During this time, you can:

• Switch to another Medicare Advantage Plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.
• Disenroll from our plan and obtain coverage through Original Medicare. If you choose to switch to Original Medicare during this period, you have until March 31 to join a separate Medicare prescription drug plan to add drug coverage.

Your membership will end on the first day of the month after you enroll in a different Medicare Advantage plan or we get your request to switch to Original Medicare. If you also choose to enroll in a Medicare prescription drug plan, your membership in the drug plan will begin the first day of the month after the drug plan gets your enrollment request.

In certain situations, plan members may be eligible to end their membership at other times of the year. This is known as 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. The enrollment periods vary depending on your situation. These are just examples, for the full list you can contact the plan, call Medicare, or visit the Medicare website. (By clicking on this link, you will be taken to the Medicare website.)

• Usually, when you have moved.
• If you have Medicaid.
• If you are eligible for “Extra Help” with paying for your Medicare prescriptions.
• If we violate our contract with you.
• If you are getting care in an institution, such as a nursing home or long-term care (LTC) hospital.
• If you enroll in the Program of All-inclusive Care for the Elderly (PACE)

To find out if you are eligible for a Special Enrollment Period, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users call 1-877-486-2048. 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.

Your membership will usually end on the first day of the month after we receive your request to change your plan. If you leave PHP, 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. 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).

Usually, to end your membership in our plan, you simply enroll in another health plan during one of the enrollment periods described above. However, if you want to switch from our plan to Original Medicare without a Medicare prescription drug plan, you must ask to be disenrolled from our plan. Contact Member Services and ask to be disenrolled from the plan or 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.

For more information about ending your membership with the plan, please see Chapter 10 in the 2024 Evidence of Coverage, or contact Member Services.