Members

2012 iCare Family Care Partnership
Notice for Potential Contract Termination

Notice for Potential Contract Termination

Independent Care Health Plan (iCare) is authorized by law to refuse to renew its contract with the Centers for Medicare and Medicaid Services (CMS). CMS may also refuse to renew its contract with iCare. If the contract between iCare and CMS is not renewed or terminated, this may result in the termination of your enrollment in the iCare Family Care Partnership (HMO SNP). In addition, iCare may reduce its service area and have the right to no longer offer services in the area where the beneficiary resides. If this occurs, you will receive another notice and instructions for continuity of care.

Ending Your Membership in the Plan

You may end your membership in our plan at any time. For more information about your Medicaid options, contact your Team.

For people enrolled in Medicare, Medicare requires that your membership end on the last day of the month following the month you sign a disenrollment form. The following two Medicare enrollment periods do not apply to you because you are enrolled in Medicaid:

The Annual Enrollment Period. This is the time when most people enrolled in Medicare health and drug coverage make a decision about their coverage for the upcoming year. This happens every year from November 15 to December 31.

The Open Enrollment Period. This is the time when most people enrolled in Medicare health and drug coverage have the opportunity to make one change to their health coverage. This happens every year from January 1 to March 31. For choices made during this period, membership will end on the first day of the month after your request to change plans.

Because you are enrolled in Medicaid, members of iCare Family Care Partnership (HMO SNP) are eligible to end their Medicare membership at any time of the year.

For members with Medicare coverage this is known as a Special Enrollment Period.

What can you do? If you are enrolled in Medicare end your Medicare membership in Partnership, you can choose to change both your Medicare health coverage and prescription drug coverage. This means you can choose any of the following types of plans:
- Another Medicare Advantage plan. (You can choose a plan that covers prescription drugs or one that does not cover prescription drugs.)
- Original Medicare with a separate Medicare prescription drug plan.
- – or – Original Medicare without a separate Medicare prescription drug plan.
  Note: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. ("Creditable" coverage means the coverage is at least as good as Medicare's standard prescription drug coverage.)
  Note: If you disenroll from a Medicare prescription drug plan and go without creditable prescription drug coverage, you may need to pay a late enrollment penalty if you join a Medicare drug plan later. ("Creditable" coverage means the coverage is at least as good as Medicare's standard prescription drug coverage.)

When will your Medicare membership end? Your Medicare membership will usually end on the first day of the month after we receive your request to change your plan.

A NOTE ABOUT MEDIGAP RIGHTS: If you will be changing to the Original Medicare Plan you might have a special temporary right to buy a Medigap policy, also known as Medicare supplement insurance, even if you have health problems. For example, if you are age 65 or older and you enrolled in Medicare Part B within the past 6 months or if you move out of the service area, you may have this special right. Federal law requires the protections described above. Your State may have laws that provide more Medigap protections. For information, you can contact the Wisconsin Board on Aging and Long-Term Care at 1402 Pankratz Street, Suite 111, Madison, WI, 53704 or call the Medigap Helpline, a service of the Board on Aging and Long-Term Care at 1-800-242-1060 or the Medicare Counseling Service, provided by Southeastern Wisconsin Area Agency on Aging at 1-877-333-0202. You can also find the website for the Wisconsin Board on Aging and Long-Term Care at www.medicare.gov on the web. Under "Search Tools," select "Helpful Phone Numbers and Websites." The state of Wisconsin also has Ombuds who can help you with questions or problems. Call 1-800-760-0001 to speak to an Ombuds.

Call 1-800-MEDICARE (1-800-633-4227) for more information about trial periods. TTY users should call 1-877-486-2048. If you need any help, please call us at call (800) 777-4376, Monday through Friday, 8:00 a.m. to 8:00 p.m. TTY users should call (800) 947-3529. We are open Monday through Friday, 8:00 a.m. to 8:00 p.m. Thank you.

Involuntary Disenrollment

iCare Family Care Partnership (HMO SNP) must end your membership in the plan if any of the following happen:

If you lose your financial eligibility for Wisconsin Medicaid.
If you are no longer functionally eligible as determined by the State of Wisconsin Long-Term Care Functional Screen.
If you do not pay your Medicaid cost share. We will tell you in writing that you have up to a 30 day grace period during which you can pay your cost share before we end your membership.
If you do not stay continuously enrolled in Medicare Part A and Part B.
If you become eligible for Medicare Part A, Part B and Part D benefits and refuse to enroll in Medicare Part A, B or D benefits.
If you move out of our service area. If you move or take a long trip, you need to call your Team.
If you lie about or withhold information about other insurance you have that provides prescription drug coverage.
If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
If you continuously behave in a way that is disruptive or unsafe to staff, providers or other members. This makes it difficult for us to provide care for you and other members of our plan. We cannot make you leave our plan for this reason unless we first get permission from Medicaid and, if applicable, Medicare.
If you let someone else use your membership card to get medical care. If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General. Wisconsin Medicaid may also investigate the case.
If you do not pay the Medicare Part B premiums for 30 days. We must notify you in writing that you have 30 days to pay the plan premium before we end your membership.

We Cannot Ask You to Leave the Plan for any Reason Related to Your Health

If you feel that you are being asked to leave our plan because of a health-related reason, you should call MetaStar at 1-888-203-8338. If you have Medicare, you should call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You may call 24 hours a day, 7 days a week.

You Have the Right to File a Grievance if We End Your Membership in the Plan

If we end your membership in our plan, we must tell you our reasons in writing for ending your membership. We must also explain how you can file a grievance about our decision to end your membership. Click here for information about how to make a grievance.

Contact Us

Questions? Call us at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m. Our mailing and walk-in address is: Independent Care Health Plan, 1555 N. RiverCenter Dr., Suite 206, Milwaukee, WI 53212.

Last Updated: 11/03/2011