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  • Aetna Disenrollment Form

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X 963 Blue Bell, PA 19422-9921 If you have questions, call 1-800-832-2640 or TTY/TDD 1-800-628-3323, Monday-Friday 8:00 a.m. 6:00 p.m. To enroll in the Aetna Medicare Advantage Plan, provide the following information. Check the box next to the plan you want to enroll in. Please refer to plan materials for detailed benefit information. Aetna Golden Medicare Plan (HMO)* Aetna Golden ChoiceTM Plan (PPO) Basic Select Premier Standard Regional Regional Standard Standard Value Premier Regional V.

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If you're already in a Medicare Advantage plan and you want to switch to traditional Medicare, you should contact your current plan to cancel your enrollment and call 1-800-MEDICARE (1-800-633-4227). Note there are specific enrollment periods each year to do this.

: to remove (as a name) from a roll. broadly : to release (an individual) from membership in an organization (as from a military reserve) disenrollment. "+ noun.

• Written by Anna Porretta. The Medicare Advantage Disenrollment Period (MADP) is when you can disenroll from a Medicare Advantage plan and return to Original Medicare. This period occurs every year from January 1 to February 14.

Involuntary Disenrollment The individual moves out of the plan's service area and becomes ineligible to be enrolled with Blue Cross MedicareRx. The individual loses entitlement to Medicare. The individual dies. The individual fails to pay any premiums or late enrollment penalty.

"Disenrollment" means leaving Health Partners Medicare and no longer being a member. You may leave one of our plans because you decide that you want to leave. This is called voluntary disenrollment. To leave our plan, in most cases you can simply enroll in another health plan during an available election period.

To disenroll from a Medicare drug plan during Open Enrollment, you can do one of these: Call us at 1-800 MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. Mail or fax a signed written notice to the plan telling them you want to disenroll.

In some circumstances, disenrollment is voluntary; in others, beneficiaries are forced to disenroll. For instance, beneficiaries may be required to disenroll if they change residences outside the plan's service area, lose Medicare eligibility, or if Medicare terminates a plan's contract.

"Disenrollment" means leaving Health Partners Medicare and no longer being a member. You may leave one of our plans because you decide that you want to leave. This is called voluntary disenrollment.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232