Disenrollment Rights and Responsibilities

• Move your permanent residence out of the plan's service area (including incarceration).
• Lose your entitlement to Medicare benefits under Part A and/or are no longer enrolled in Part B.
• Knowingly misrepresent that you expect to receive reimbursement for covered Medicare prescription drug plan drugs through other third-party coverage.
• Fail to pay the monthly premium after your plan has made reasonable efforts to collect the unpaid premium.
• Enroll in a different prescription drug plan. You will automatically be disenrolled from your previous plan.
• Become deceased.
• Fail to pay your Part D-IRMAA to the government and CMS notifies the plan to effectuate the disenrollment.

In all cases of disenrollment, your plan is required to provide proper notice to you and give you the opportunity to file a grievance of the decision prior to disenrollment.

Potential for contract termination
Availability of coverage or service areas beyond the end of the current contract year is not guaranteed. Termination or non-renewal of the contract by Centers for Medicare & Medicaid Services (CMS) or UnitedHealthcare® Insurance Company as authorized by law may end your enrollment in the plan. If this occurs, you will be able to choose another plan without incurring a late enrollment penalty, as long as you do it within the time period required.