Disenrolling From Your Plan

There may be a time you need to disenroll from, or leave, the plan. This means your membership in Blue Cross MedicareRx is ending. If you move out of the service area, your disenrollment is considered voluntary. There are also various reasons your disenrollment can be considered involuntary. All members can leave the plan during the Annual Enrollment Period. No matter the reason, we are never allowed to ask you to leave the plan because of your health.

You may end your membership in our plan during certain times of the year, known as enrollment periods. All members have the option to leave the plan during the Annual Enrollment Period between October 15 and December 7. If you qualify for a Special Enrollment Period, you may be eligible to leave the plan at other times of the year.

To voluntarily disenroll:

• You must choose to leave the Plan.
• You must provide a signed written notice to Blue Cross MedicareRx (or, if enrolled through your employer group, the employer group must provide Blue Cross MedicareRx with the request to disenroll you).
• Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. If you are hearing or speech impaired, please call 1-877-486-2048.

Blue Cross and Blue Shield of New Mexico (BCBSNM) must disenroll a person from Blue Cross MedicareRx in these cases:

• The individual moves out of the plan’s service area and becomes ineligible to be enrolled with Blue Cross MedicareRx.
• The individual loses entitlement to Medicare.
• The individual dies.
• The individual fails to pay any premiums or late enrollment penalty.
• The individual enrolls in a different Medicare Advantage, Medicare Advantage Prescription Drug plan or stand-alone Medicare Prescription Drug plan.
• The Blue Cross MedicareRx contract is terminated or BCBSNM discontinues offering Blue Cross MedicareRx in any portion of the area where it had previously been available.
• The individual intentionally misrepresents information to BCBSNM regarding reimbursement for third-party coverage.