Sus derechos tras la cancelación de su inscripción | Allwell de Buckeye Health Plan

Medicare Member Disenrollment

Do you want to disenroll from your Wellcare By Allwell Medicare plan?  We’re sorry to see you go!

You can use the Disenrollment Form to disenroll from your  Wellcare By Allwell Medicare plan.  Note that if you request disenrollment, you must continue to get all medical care from your plan until the effective date of disenrollment. Contact Us to verify your disenrollment before you seek medical services outside of our network. We will notify you of the effective date of your disenrollment from the plan following receipt of this form.

Instructions

You may type to complete the:

Disenrollment Form English - (PDF)

To do so, download and complete the form on your computer.

Please mail or fax your completed form.

For more information on disenrollment, including your rights and responsibilities upon disenrollment, refer to the following chapters in your Evidence of Coverage: Chapter 10 on Disenrollment and Chapter 8 on Member Rights and Responsibilities