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Disenrollment Rights and Protections

Ending your membership in our Plan may be voluntary (your own choice) or involuntary (not your own choice), but there are some exceptions.

If any of the following situations apply to you, you are eligible to end your membership during a Special Enrollment Period. These are just examples, for the full list you can contact the Horizon BCBSNJ, call Medicare, or visit the Medicare Website.

  • You move to an address outside your plan’s 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 (LTC) hospital.
  • If you enroll in the Program of All-inclusive Care for the Elderly (PACE).

Our Plan 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. If you become incarcerated (go to 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.
  • 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 you have any questions or would like more information on when you can end your membership: You can call Member Services at 1-800-365-2223 (TTY 711), Monday to Sunday, 8am to 8 pm, or you can contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week (TTY 711)

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