Form HCA51-0556 Pebb Medicare Advantage Plan Disenrollment Form - Washington

What Is Form HCA51-0556?

This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the Form HCA51-0556?
A: Form HCA51-0556 is the Disenrollment Form for the Pebb Medicare Advantage Plan in Washington.

Q: What is the Pebb Medicare Advantage Plan?
A: The Pebb Medicare Advantage Plan is a healthcare plan for eligible individuals in Washington that combines Medicare benefits with additional coverage.

Q: Who is eligible for the Pebb Medicare Advantage Plan?
A: Eligible individuals include retirees, their dependents, and eligible employees of participating public employers in Washington.

Q: What is the purpose of the Disenrollment Form?
A: The Disenrollment Form is used to voluntarily end your membership in the Pebb Medicare Advantage Plan.

Q: What information is required on the form?
A: The form will require your personal information, including your name, address, Medicare number, and reasons for disenrollment.

Q: Are there any deadlines for submitting the Disenrollment Form?
A: Yes, there are specific deadlines for submitting the form. Please refer to the instructions provided with the form for more information.

Q: What happens after submitting the Disenrollment Form?
A: After submitting the form, your coverage under the Pebb Medicare Advantage Plan will end, and you will need to seek alternative healthcare coverage.

Q: Can I reenroll in the Pebb Medicare Advantage Plan after disenrollment?
A: In most cases, you will not be able to reenroll in the plan until the next available enrollment period. Please consult the plan or administrative office for more information.

Q: Who should I contact if I have further questions about the Disenrollment Form?
A: For further questions about the Disenrollment Form or the Pebb Medicare Advantage Plan, you can contact the plan's customer service or the appropriate administrative office.