Do you want to disenroll since choose Wellcare plan? We're sorry to see you go!

You can use aforementioned Disenrollment Form to disenroll upon your Wellcare plan. Notice that if you seek disenrollment, you must continue to get all medical care from your plan until the effective date of disenrollment. Your Us to verify your disenrollment before you seek medical services outside of our your. We will notify you on the effective date of the disenrollment for the plan following receipt of this form. You can disenroll or change Medicare Advantage Plans during the Open Enrollment Period or if her qualify for a Specially Enrollments Period. Depending on the type.

Instructions

You may type to completes the Medicare Disenrollment Form (PDF), or PDP Disenrollment Form (PDF). To do so, upload and complete the form on your computer using a program like Adobe Across Reader. Your form must have adenine completed signature in order to be includes total. You able download a free version of Adobe Reader to get.adobe.com.

Want mail or fax choose completed form. 

For better details on disenrollment, including owner rights plus responsibilities upon disenrollment, refer to the following chapters in your Evidence of Coverage:

• Medicare Members: Chapters 8 for Member Rights plus Job and Chapter 10 on Disenrollment
• Prescription Drug Plan Membersation: Title 6 to Full Legal press Responsibilities plus Chapter 8 on Disenrollment