Leaving the Plan (Disenrollment)
Losing your benefits
You will lose your AmeriHealth Caritas Iowa benefits (be disenrolled from AmeriHealth Caritas Iowa) if:
- You are no longer eligible for Medicaid or hawk-i.
- You move out of the state of Iowa service area.
- Your condition or illness could be better cared for by another plan.
- There is evidence you have engaged in fraud, forgery or unauthorized use or abuse of medical services.
- You reached the effective date of your requested disenrollment (see below for when you can ask to disenroll).
- You enroll in a program that is not eligible for Iowa Health Link, like Medically Needy, PACE or HIPP.
You will not lose your AmeriHealth Caritas Iowa benefits if:
- You have changes to the state of your health.
- You are using more medical services.
- You are uncooperative or disruptive because of your special needs or condition. This does not include when your continued enrollment in the plan seriously impairs its ability to furnish services to you or other members.
Asking to leave
You can ask to leave (disenroll) from AmeriHealth Caritas Iowa:
- For cause, at any time. This means, but is not limited to:
- You move out of the AmeriHealth Caritas Iowa service area.
- You receive poor-quality care.
- You are not able to get covered services or providers.
- You request service that we do not cover because of moral or religious objections.
- Your application and approval for the Program of All-Inclusive Care for the Elderly (PACE).
- Without cause, once every 12 months and within 90 days of your enrollment, or on the date the state sends you notice of the enrollment, whichever is later. You also have 90 days to disenroll after being re-enrolled after a temporary loss of Medicaid.
- You can disenroll from AmeriHealth Caritas Iowa without cause once every 12 months.
- You can disenroll at any time if you can’t get all of the services you request at one time within our network.
- You can disenroll at any time if the state sanctions the plan, resulting in temporary management or the plan having to pay a financial penalty.
Disenrollment from AmeriHealth Caritas Iowa is effective on the first day of the following month or no later than the first day of the second month.
How to disenroll
- File a grievance.
- If you still are not happy after your grievance is over, we will help you get in touch with an Enrollment Broker.
- We will give a copy of your grievance to the Enrollment Broker. The Enrollment Broker will approve or deny your request to leave the plan.
Call the Iowa Medicaid Enterprise with questions at 1-800-338-8366. For hawk-i members, call Healthy and Well Kids in Iowa (hawk-i) Member Services at 1-800-257-8563.