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Potential for Contract Termination

IlliniCare Health is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Being a member of IlliniCare Health depends on contract renewal between the State of Illinois and Medicare.

Medicare and Illinois Medicaid must end your membership in the plan if:

  • Your coverage in Medicare Part A and Part B stops. Medicare services will end on the last day of the month that your Medicare Part A or Medicare Part B ends.
  • You no longer qualify for Illinois Medicaid.
  • You no longer meet Illinois Medicaid eligibility requirements. Our plan is for people who qualify for both Medicare and Illinois Medicaid.
  • You move out of our service area.
  • You are away from our service area for more than six months.
  • You find primary housing outside of Illinois.
  • If you move or take a long trip, call Member Services to find out if you are going in our plan’s service area.
  • You go to jail.
  • You lie about or do not tell us information about other insurance you have for prescription drugs.

We can ask Medicare and Illinois Medicaid to end your membership with our plan if:

  • You intentionally lie when you are signing up and that information makes you eligible.
  • You cause problems and make it difficult for us to offer medical care for you and other members.
  • You let someone use your ID card to get medical care.

If your membership ends for these reasons, Medicare and/or Illinois Medicaid may have your case investigated by the Inspector General. Criminal and/or civil prosecution is also possible.

Your Rights upon Disenrollment:

If we ask Medicare and Illinois Medicaid to end your membership, we must tell you why in writing. We will also tell you how to make a complaint about ending your membership. See the Appeals and Grievances section of this website for information about how to make a complaint.

 

Last Updated: 02/08/2018
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