Health Net does not, either verbally or in writing or by any action or inaction, request or encourage a Medicare member to disenroll. However Health Net must disenroll a member from a Medicare Advantage plan due to death, failure to pay the Part D-Income Related Monthly Adjustment Amount (IRMAA), a move outside of the plan's service area, including incarceration, loss of Medicare Part A or Part B, loss of special needs status (if the member is enrolled in a Special Needs Plan (SNP)), or a non-renewal or service area reduction. Health Net may disenroll a member if the member engages in disruptive behavior, provides fraudulent information on an enrollment request or if the member permits abuse of an identification card (ID).

Health Net has the right to disenroll a Health Net Medicare Advantage (MA) member under the following circumstances, for instance:

A member may disenroll by:

The election period during which Health Net receives a valid request to disenroll will determine the member's effective date of disenrollment. After the member submits a request, Health Net must provide the member with a disenrollment notice within ten calendar days of the request to disenroll. The notice will provide the effective date of disenrollment. If Health Net receives a disenrollment request that must be denied, the member will be notified within ten calendar days of the receipt of the request. The notice will include the reason for the denial. Health Net continues to be responsible for the member's health care until disenrollment is approved by Centers for Medicare and & Medicaid Services (CMS).

To request disenrollment of a Medicare member, providers may contact the Medicare Programs Provider Services Department. Providers are asked to describe the circumstances leading them to request the disenrollment and may be asked to submit documentation regarding their requests. If necessary, Health Net reassigns the member to a new primary care physician (PCP) within the plan. If reassignment is not possible and the member requires disenrollment based on the guidelines outlined below, then Health Net sends the information to Centers for Medicare & Medicaid Services (CMS) for approval or disapproval of the disenrollment request. Health Net cannot terminate Medicare members without CMS approval. Once the disenrollment has been approved, a letter is sent to the member.

A provider-initiated disenrollment request based on the breakdown of the provider-member relationship is considered good cause and is approved by CMS only if one or more of the following circumstances occur:

Failure to follow prescribed treatment, including failure to keep appointments, is not, in itself, good cause for disenrollment.

Health Net may request to disenroll a member if their behavior is disruptive to the extent that they continued enrollment in the Medicare Advantage (MA) plan substantially impairs Health Net's ability to arrange for or provide services to either that particular member or other members of the plan. However, Health Net may disenroll a member for disruptive behavior only after Health Net has met the requirements outlined in chapter 2 of the Medicare Managed Care Manual, Section 50.3.2 and obtained CMS approval.

Before requesting CMS approval of disenrollment for disruptive behavior, Health Net must make a serious effort to resolve the problems presented by the member. Such efforts must include providing reasonable accommodations, as determined by CMS, for individuals with mental or cognitive conditions, including mental illness and developmental disabilities. Health Net must also inform the individual of their right to use Health Net's grievance procedures.

The Centers for Medicare & Medicaid Services (CMS) can approve retroactive disenrollment in the following instances:

A written request for retroactive disenrollment must be submitted to the Health Net Medicare Programs Member Services Department by the member. Depending on the circumstances, CMS may approve a partial disenrollment.

When a Health Net Medicare Advantage (MA) plan member disenrolls through an employer group, there may be a delay in processing the disenrollment request. In these cases, the CMS allows a retroactive disenrollment not to exceed 90 days.

A member may only disenroll from a plan during one of the specified election periods. The member must submit a written request to the Member Services Department or through his or her employer. The written request must be signed by the member or member representative before the disenrollment date. The member may choose an effective date of up to three months after the month in which the individual completed a disenrollment request; however the effective date of disenrollment may not be earlier than the first of the month following the month in which the request was made.

When a member enrolls in another MA plan, the member is automatically disenrolled from Health Net's MA plan at the time the membership in the new MA plan becomes effective. In these situations, the member should not submit a written request for disenrollment to his or her health plan.