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Rights and Responsibilities Upon Disenrollment

When We Must End Your Membership

By law, SFHP Care Plus cannot remove you from the plan for any reason because of your health status. If you believe your membership ended unfairly, you can call Medicare 24/7 for help:

• 1-800-MEDICARE (1-800-633-4227)
• TTY: 1-877-486-2048

Membership will end if:

• You no longer have Medicare Part A and or Part B.
• You lose Medi-Cal eligibility through San Francisco Health Plan (the state will automatically return you to Original Medicare).
• You move outside of our service area (San Francisco County) for more than 6 months.
• You are in prison.
• You become unlawfully present in the U.S.
• You give false or incomplete information about other prescription drug coverage you may have.

Membership may end (with Medicare/Medi-Cal approval) if:

• You purposely gave false information when joining the plan that affects your eligibility.
• Your ongoing behavior disrupts the care of other members and makes it hard for us to provide services.
• You let another person use your SFHP Care Plus member ID card.

If your membership ends for these reasons, Medicare may request a review from the Inspector General.

How to Prevent Disenrollment

• Let Customer Service know if you’ll be outside of San Francisco County for longer than 6 months.
• Report any address changes right away to the San Francisco Medi-Cal Office.
• Make sure you finish your Medi-Cal renewal each year. If you need help, call:
  • San Francisco Medi-Cal Office to renew your coverage at 1(855) 355-5757 (toll-free).
  • Or call SFHP Care Plus Customer Service for support.

Ways to Disenroll from SFHP Care Plus

• You can choose to leave SFHP Care Plus (HMO D-SNP) at any time for any reason.
• If you decide to leave, your membership will stop at the end of the month in which we receive your request.

You will still receive Medi-Cal benefits through San Francisco Health Plan.

1. Call SFHP Care Plus Customer Service
   • Phone: 1(415) 539-2273, 1(833) 530-7327 (toll-free), or 711 (TTY)
   • Hours: We are open 8:00am-8:00pm, seven days a week from October–March. We are closed on Saturdays and Sundays from April–September.
   • Email: [email protected]
2. Send us a signed request
   You may mail a letter to SFHP Care Plus Member Eligibility at:

   SFHP Care Plus Member Eligibility
   ATTN: Member Eligibility
   PO Box 194247
   San Francisco, CA 94119

   SFHP Care Plus Disenrollment Form

3. Join a different plan
   If you join a different Medicare Advantage plan, you will be automatically disenrolled from SFHP Care Plus. You can disenroll from SFHP Care Plus at any time during the year.

   However, timeframes and reasons determine when you can change Medicare Advantage plans. Check the Medicare and You Handbook on Medicare.gov for more information.

Care During Your Transition

If you get care outside of SFHP Care Plus’s network before your disenrollment takes effect, you might be responsible for the costs if the provider doesn’t bill SFHP Care Plus. To help avoid any surprises on your bill, call Customer Service to confirm your disenrollment date before you make appointments outside of our network.

Need Support?
Call SFHP Care Plus Customer Service:

• Phone: 1(415) 539-2273, 1(833) 530-7327 (toll-free), or 711 (TTY)
• Hours: We are open 8:00am-8:00pm, seven days a week from October–March. We are closed on Saturdays and Sundays from April–September.
• Email: [email protected]