Your Rights Upon Disenrollment | Allwell from Western Sky Community Care
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.
You may type to complete the:
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