WAG 20-24-02: Leaving an MCO

PM 20-24-02.

  • New Text.All customers who are required to enroll in a HealthChoice Illinois or YouthCare plan must stay enrolled. Customers may not voluntarily disenroll from the HealthChoice Illinois or YouthCare plan. HealthChoice Illinois and YouthCare customers may switch plans only during their open enrollment period once a year.
  • Dual eligible customers enrolled in the Medicare-Medicaid Alignment Initiative (MMAI) program may opt out of or switch MMAI plans at any time. Dual eligible customers who opt out of the MMAI program and are receiving waiver services or long-term care services must enroll with a HealthChoice Illinois Managed Long Term Services and Supports (MLTSS) health plan for their MLTSS services only. Once opted out, MMAI eligible customers may also choose to re-enroll in the MMAI program again at any time by contacting Illinois Client Enrollment Services (ICES)1-877-912-8880, (TTY: 866-565-8576).
  • Approximately 75 days prior to the customer's effective plan enrollment date, the customer will receive an Open Enrollment letter from ICES detailing their health plan choices and the date by which any health plan change must be made. The customer does not have to take any action if they would like to stay in the same Managed Care Organization (MCO). Refer all inquiries about enrollment changes and dates to ICES.

The customer's "Next Enrollment Period Begin Date" can be found on the Individual Summary Page.

The customer's anniversary date is the "Anniv Dte" in the Recipient Database (PF8).

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