Pre-Enrollment Disclaimer
Community Health Group (HMO) contract with CMS is renewed on an annual basis, the availability of coverage
beyond the need of the current contract year is not guaranteed. You must continue to pay your Medicare Part
B premium if not otherwise paid for under Medicaid or by another third party.
How to Enroll or Disenroll
Enrolling in CommuniCare Advantage (HMO-SNP) Plan is easy. It's simple!
- Call our Member Services representatives who will explain the plan and answer your questions at 1-888-244-4430
(TTY 1-800-735-2929). CommuniCare Advantage (HMO-SNP) Plan representatives are available 24 hours a day, 7 days
a week, including holidays.
- If you live in San Diego County and you are receiving Medi-Cal and Medicare benefits, you can sign up for
CommuniCare Advantage (HMO-SNP) at any time. It's a simple way to combine your Medi-Cal and Medicare benefits into one easy
to use health care plan.
- No premiums, no deductibles, no co-pays. You pay zero dollars out of your pocket for doctor's visits,
emergency services or hospitalization.
- Non-emergency transportation for 18 round-trip visits to the doctor per year.
- Annual home safety assessment including installation of bathroom and/or shower grabs bars (not to exceed $800 per year).
- Worldwide emergency services (excludes transportation back to the U.S.).
We will call you to schedule a presentation after you have completed the Reply Form.
Please note that Adobe Acrobat Reader is required to view this reply form. If you do
not have it installed, click here
to download this free utility software.
You can also fill out the enrollment form, just fill out,
sign it and mail it to us.
Please mail your signed completed form to:
CommuniCare Advantage (HMO-SNP)
Care of: Marketing Division
740 Bay Boulevard
Chula Vista, CA 91910
Disenrolling from CommuniCare Advantage (HMO-SNP) Plan.
Ending your membership in our Plan may be voluntary (your own choice) or involuntary (not your own choice):
- You might leave our Plan because you have decided that you want to leave.
- There are also limited situations where we are required to end your membership.
For example, if you move permanently out of our geographic service area.
If you leave our Plan, it may take some time for your membership to end and your new way of getting Medicare
to take effect. While you are waiting for your membership to end, you are still a member and must continue
to get your medical care and prescription drugs through our Plan.
If we end your membership in our plan, we must tell you our reason(s) in writing for ending your membership.
We must also explain how you can make a complaint about your decision to end your membership.
For details about ending your membership in CommuniCare Advantage, please call ourMember Services representatives at 1-888-244-4430
(TTY 1-800-735-2929) or see the Evidence of Coverage.
Disclaimer Information:
CommuniCare Advantage (HMO-SNP) is a Medicare Advantage organization with a Medicare contract.
You must continue to pay your Medicare Part B premium if not otherwise paid for under Medi-Cal or by a third party. You must
use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care
from out-of-plan providers, neither Medicare nor CommuniCare Advantage (HMO-SNP) will be
responsible for costs. You must use network pharmacies to fill your prescriptions, except under non-routine circumstances when
you cannot reasonably use network pharmacies.
Plan member materials are available in other formats (Spanish) upon request.
For full information on CommuniCare Advantage (HMO-SNP) plan benefits, please call our
Member Services department at 1-888-244-4430 (TTY 1-800-735-2929). CommuniCare Advantage (HMO-SNP) Plan representatives are available 24 hours a day, 7 days a week, including holidays.
How To Change To A Different Plan
If you decide to leave CommuniCare Advantage (HMO-SNP), you can switch to a different Medicare Advantage
plan or to Original Medicare (either with or without a separate Medicare prescription drug plan).
If you want to change to a different plan, there are many choices. Medicare Advantage plans AND/OR Medicare prescription drug plans
in addition to the plan you are now enrolled in. These other plans may differ in coverage, monthly premiums, and cost sharing amounts.
Beneficiaries who are eligible to join Community Health Group's Medicare Advantage Special
Needs Plan may enroll or disenroll at any time.
How do you make a change?
See Chapter 10 of the enclosed Evidence of Coverage document. It tells what you need to do.
|