Enrollment and Disenrollment

Membership Enrollment and Disenrollment Rights

How do you enroll in our plan?

HealthSun Health Plans will accept enrollment requests that are received during face-to-face interviews. The person discussing the benefits with you during the face-to-face interview is employed by HealthSun Health Plans and may be compensated for your enrollment into the plan. Once enrolled as a HealthSun member you will also receive an identification card within seven days from receipt of enrollment. The identification card is to be used for all your medical services and prescription drug coverage.

Medicare beneficiaries may also enroll in HealthSun Health Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

You can also contact our Member Services Department at (305) 447-4458 or (877) 336-2069 or TTY (877) 206-0500 Monday through Friday from 8:00 a.m. - 8:00 p.m.

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Beneficiaries with both Medicare Part A and Part B can choose to enroll in a Medicare Advantage Plan from October 15 to December 7 of every year using the “Open Enrollment” Election. You must reside in the service area of the plan. 

Typically, beneficiaries cannot enroll in a Medicare Advantage Plan outside of the Open Enrollment Period. However, in certain situations a Special Election Period (SEP) may be used during the other months of the year so that beneficiaries may be able to join, switch, or drop a Medicare Advantage HMO plan or a Prescription Drug plan. If you have any questions, please contact our Member Services Department at (305) 447-4458 or (877) 336-2069. TTY users should call (877) 206-0500. You may call seven days a week, from 8:00 a.m. - 8:00 p.m. 

Please remember that if you are already enrolled in one of the HealthSun Health Plans HMO benefit plans, you should not enroll in a stand-alone Part D plan (PDP) as your plan includes a prescription drug plan. Enrollment into a PDP plan will automatically disenroll you from HealthSun, your Medicare Advantage HMO Plan. 

HealthSun Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. Please note that HealthSun Health Plans and/or the Centers for Medicare and Medicaid Services (CMS) may choose to terminate their contract which will result in termination of enrollment in the plan. In addition, the plan may reduce its service area and no longer offer services in the area the beneficiary resides.

Membership Disenrollment

How do you end your membership in our plan?

Usually, to end your membership in our plan, you simply enroll in another Medicare plan during one of the enrollment periods. 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. There are two ways you can ask to be disenrolled:

  • You can make a request in writing to us. Contact Member Services if you need more information on how to do this (phone numbers are printed on the back cover of your “Evidence of Coverage” (EOC)).
  • -or- 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.

Beneficiaries' and plans' rights and responsibilities upon disenrollment

HealthSun Health Plans upon receipt of a disenrollment request will send a disenrollment acknowledgement letter to the member within ten calendar days. Once CMS confirms the disenrollment, the plan will send a disenrollment confirmation letter to the member. These notices include explanations of restrictions during the lock-in period and the effective date of the disenrollment. You must continue to use the plan until the disenrollment is effective.

If you switch to Original Medicare and do not enroll in a separate Medicare prescription drug plan, Medicare may enroll you in a drug plan, unless you have opted out of automatic enrollment. If you disenroll from Medicare prescription drug coverage 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 expected to pay, on average, at least as much as Medicare's standard prescription drug coverage.) See Chapter 6, Section 9 of your EOC for more information about the late enrollment penalty.

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. If you are eligible to end your membership, 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 health plan that either covers prescription drugs (MA-PD) or one that does not cover prescription drugs (MA Plan).
  • Original Medicare with a separate Medicare Prescription Drug Plan (stand-alone PDP).
  • -or- Original Medicare without a separate Medicare prescription drug plan.

Annual Open Enrollment Period (AEP)

All members have the opportunity to leave the plan during the Annual 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.  This happens from October 15 to December 7.  If you select to enroll in a new plan, then your membership will end when your new plan's coverage begins on January 1.  You must continue to use the plan until your disenrollment is effective. 

Special Enrollment Period (SEP)

In certain situations, you may also be eligible to leave the plan at other times of the year.  If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period (SEP):

  • If you have moved out of the plan service area.
  • 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 hospital.
  • If you enroll in the Program of All-inclusive Care for the Elderly (PACE).

These are some examples, for the full list you can contact the plan, call Medicare, or visit the Medicare Web site (http://www.medicare.gov).  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 call1-877-486-2048. 

Annual Medicare Advantage Disenrollment Period (MADP)

You may also end your membership during the annual Medicare Advantage Disenrollment Period (MADP), this happens from January 1 to February 14.  During this period you can cancel your Medicare Advantage Plan enrollment and switch to Original Medicare.  If you choose to switch to Original Medicare during this period, you have until February 14 to join a separate Medicare prescription drug plan to add drug coverage.  Your membership will end on the first day of the month after 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.

HealthSun must end your membership in the plan in certain situations

HealthSun 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.
  • If you are away from our service area for more than six months.
  • If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan's area. (Phone numbers for Member Services are printed on the back cover of your EOC.)
  • If you become incarcerated (prison).
  • 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. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • 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. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
  • If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.

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 Chapter 9, Section 10 of your EOC for more information about how to make a complaint.  HealthSun is not allowed to ask you to leave our plan for any reason related to your health.   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.

Do you have enrollment questions? We’re here to help.

Phone: (305) 447-4458
Toll-free: (877) 336-2069
TTY Users: (877) 206-0500
Hours: Monday-Friday from 8:00 a.m. - 8:00 p.m.

From October 1 to February 14, we are open 7 days a week from 8:00am to 8:00pm.  From February 15 to September 30, we are open Monday through Friday from 8:00am to 8:00pm

Enrollment Application

2018

2017

Address Change Form

Disenrollment Form

Member Rights and Responsibilities Upon Disenrollment

For further information on disenrollment rights and responsibilities please contact our Member Services Department at (305) 447-4458 or (877) 336-2069. TTY users should call (877) 206-0500. We are available Monday through Friday from 8:00 a.m. - 8:00 p.m.

If we end your membership with our health plan we will inform you of our reason in writing and explain how you may file a complaint against us if you wish to do so.

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