Rights and Responsibilities

Pharmacy Benefit Dimensions' Responsibilities

Upon your (member) disenrollment from the plan, Pharmacy Benefit Dimensions must:

• Provide you with an acknowledgement and confirmation of disenrollment notice.
• Provide you with a denial of or rejection by CMS of disenrollment, if applicable.
• Inform you about Medigap rights during a special enrollment period.
• Provide advance notice in the event you are involuntarily disenrolled and explain reasons for disenrollment.
• Provide advance notice in the event your enrollment in a Prescription Drug Plan is ending.
   

Pharmacy Benefit Dimensions must end your membership if any of the following happen:

• If you do not stay continuously enrolled in Medicare Part A & Part B.
• If you move out of our service area.
• If you are away from our service area for more than six months in a row.
  • If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our plan’s area. (Phone numbers for Member Services are located in the right column.)
• If you have been a member of our plan continuously since before January 1999 and you were living outside of our service area before January 1999, you may continue your membership. However, if you move and your move is to another location that is outside of our service area, you will be disenrolled from our plan.
• If you become incarcerated (go to prison).
• 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. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical 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 medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.) If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.
• If you do not pay the plan premiums for 90 days. We must notify you in writing that you have 90 days to pay the plan premium before we end your membership.
• If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.
 

Member Responsibilities

• You must make a written request for disenrollment prior to the 1st of the month in which disenrollment is intended.
• Please contact your group administrator to understand when you may be able to disenroll from your plan.
   

Member Notifications

• You will be advised that upon disenrollment from a Part D plan, that unless you obtain another Part D plan, or otherwise elect another type of creditable prescription drug coverage, that you may be subject to a Late Enrollment Penalty should a lapse in coverage occur for 63 or more days.
• You will be reminded that if you do not enroll in another Medicare Advantage Plan or Medicare Advantage Plan with Prescription Drug coverage, that you will be enrolled in Original Medicare.

Pharmacy Benefit Dimensions is a subsidiary of Independent Health. Independent Health is a PDP with a Medicare contract. Enrollment in Pharmacy Benefit Dimensions PDP depends on contract renewal between Independent Health and CMS.