A member may request disenrollment from Colorado Choice Health Plans (Cost) at any time.

Disenrollment may be voluntary (your own choice) or involuntary (not your own choice). For more information regarding your rights and responsibilities please see your Evidence of Coverage, Chapter 6. For more information regarding ending your membership in the Plan, please see your Evidence of Coverage, Chapter 8.

Voluntary Disenrollment can occur by any of the following:

Enrolling in another plan – you will automatically be disenrolled from the plan when your new coverage begins;

Members may disenroll at any time by mailing, hand delivering, or faxing a signed and dated written notice to the plan:

Colorado Choice Health Plans
700 Main Street, Suite 100
Alamosa, CO  81101
(719) 589-4901  fax
Attn: Customer  Service

You can also  call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.

If you decide to disenroll from  Colorado Choice Health Plans (Cost) it may take time before your membership ends  and your new Medicare coverage goes into effect. You must continue to get your medical care through our Plan until your new Medicare coverage goes into effect.  If you need more information on disenrollment please call Customer Service at 719-589-3696 if calling from within the San Luis Valley or at 1-800-475-8466 if calling from outside the San Luis Valley. TTY users should call 1-800-659-2656.

Colorado Choice Health Plans will disenroll members involuntarily if:

If you do not stay continuously enrolled in Part B.

If you move out of our service area or you are away from our service area for more than 90 days.

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 membership card to get medical care.

If you do no pay the plan premiums.

Colorado Choice Health Plans is not allowed to ask you to leave our plan for any reason related to your health.

Should Colorado Choice Health Plans end your membership involuntarily, 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.

DISCLAIMER
Colorado Choice Health Plans is a health plan with a Medicare Contract. Enrollment in Colorado Choice’s Medicare cost plan depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

You are eligible to enroll if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and you live in the Colorado Choice Health Plans service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Eligible beneficiaries can enroll in Colorado Choice at any time.

You can use any doctor who is part of Colorado Choice’s network. You may also go to doctors outside of our network. We may not pay for services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for paying the Medicare deductible and coinsurance for those services, unless they were authorized in advance by Colorado Choice.

Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits.

Information is available in alternative formats or languages. Please call 1-800-475-8466 (TTY users should call 1-800-659-2656) for details. Se puede presentar la información acerca del plan en un formato o idioma distinto. Para solicitar un documento en español, favor de llamar a Atención al Cliente, al número telefónico indicado debajo.

For more information, contact Customer Service at 719-589-3696 if calling from within the San Luis Valley or at 1-800-475-8466 if calling from outside the San Luis Valley. (TTY users should call 1-800-659-2656). Hours are 8:00 am to 8:00 pm, 7 days a week , Oct 1 – Feb 14, and 8:00 am to 8:00 pm., Monday through Friday, Feb 15 – Sep 30.  (Para asistencia en Español, llame al 719-589-3696 o al 1-800-475-8466).

Information is current as of 6/30/2016. Please contact our Customer Services department to verify that you have the most up to date information.

H0657_2016 Website Plan Information