Member Rights and Responsibilities

Our plan must honor your rights as a member of the plan. You have the following rights to help protect you:

• We must provide information in a way that works for you (in languages other than English, in Braille, or other alternate formats, etc.).
• We must treat you with fairness and respect at all times.
• We must ensure that you get timely access to your covered drugs.
• We must protect the privacy of your personal health information.
• We must give you information about the plan, its network of pharmacies and your covered drugs.
• We must support your right to make decisions about your care.
• You have the right to make complaints and to ask us to reconsider decisions we have made.

You also have certain Rights and Responsibilities upon disenrollment. If you disenroll, remember the following during the disenrollment process:

• Until your membership ends, you must keep getting your drugs through our Plan.
• If you leave WellCare, you can join another Medicare PDP or a Medicare Advantage plan as long as this type of plan is available in your area, they are accepting new members, and you meet the eligibility requirements of the plan.
• You may only disenroll or switch plans during specific time periods each year.
• We cannot ask you to leave the Plan because of your health.

WellCare must end your membership in the plan if any of the following happen:

• If you do not stay continuously enrolled in Medicare Part A or Part B (or both).
• If you move out of the service area for more than 12 months.
  • If you move or take a long trip, you need to call customer service to find out if the place you are moving or traveling to is in our plan's service area.
• If you become incarcerated.
• If you lie 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 and 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 get permission from Medicare first.
• If you let someone else use your membership card to get prescription drugs.
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.

Member Responsibilities

Along with the rights you have as a member of our Plan, you also have some responsibilities: 

• Getting familiar with your covered drugs and the rules you must follow to get these covered drugs.
• If you have any other prescription drug coverage in addition to our plan, you are required to tell us.
• Tell your doctor and pharmacist that you are enrolled in our plan.
• Help your doctors and other providers help you by giving them information, asking questions and following through on your care.
• Pay what you owe.
• Tell us if you move.
• Call customer service for help if you have questions or concerns.

Please review our Evidence of Coverage for more detailed information on all Member Rights and Responsibilities including disenrollment situations and procedures.