Voluntary Transfers Between PPGs

Member Transfers Between PPGs in Different Regions

When a Medicare member moves from one plan contract area to another plan contract area, the member must re-enroll with the plan. The procedure for members transferring to a different region is:

• The member must notify the plan of their relocation and sign a new application form. This action disenrolls the member from their previous plan and enrolls the member into the Medicare plan.
• When the plan receives the new enrollment form, the member is transferred to a participating physician group (PPG) in the new contract area.
• When Centers for Medicare and Medicaid Services (CMS) confirms the member's new contract area enrollment, the plan sends the member a confirmation letter and a new identification card that reflects the member's new contract area PPG.
• The member's selected PPG is liable for the member's health care until the member's name is removed from the eligibility list.

Member Transfers Between PPGs in Same Region

In accordance with CMS guidelines, members may transfer between PPGs without an annual limitation. These unlimited transfer requests may be made at any time by the member. The effective date of transfer is the first day of the following month. For example, if a member requests a PPG change on July 29, the eligibility date with the new PPG is effective August 1.

All transfer requests are screened and handled by the Member Services Department. The procedure for transferring members between PPGs in the same region is:

• The plan notifies both the incoming and outgoing PPGs, as well as the member, that the transfer has been completed.
• The existing PPG assumes the expense for reproducing the member's medical records when the member transfers to another PPG.
• The effective date of eligibility with the new PPG is the first of the following month.

Mid-Month Transfers Between PPGs

In cases where a member relocates and makes a mid-month transfer to a PPG in a different region, the receiving PPG is responsible for all care, unless otherwise negotiated and agreed on by both PPGs and the plan at the time of the transfer.

The plan has the right to require a PPG to accept a mid-month transfer if based on relocation, with the capitated funds apportioned according to the date of the transfer.

PPGs continue to contact the Member Services Department to coordinate mid-month transfers.