Disenrollment Rights

SWH Whole Health FIDA Plan will not pursue disenrollment based on a participant's health status, and need for or cost of covered services.

You Can Choose to Disenroll

You may leave the SWH Whole Health FIDA Plan at any time, for any reason.

Disenrollment from a plan is effective the last day of the month. Enrollment in a new plan is effective the first day of the month.

To request disenrollment please call the NY State Enrollment Broker at 1-855-600-FIDA. They will explain your options and what programs are available to you to continue to receive all your Medicare and Medicaid services. You may also call 1-800-Medicare to disenroll and they will connect you to the NY State Enrollment Broker.

The SWH Whole Health participant services team is available to help you with any questions or even to help you leave our plan. We can be reached at 1-844-861-FIDA (3432), TTY/TDD: 711, 7 days a week 8 a.m. - 8 p.m.

You Will Have to Leave the SWH Whole Health FIDA Plan if you:

  • Permanently move out of the SWH Whole Health FIDA Plan service area;
  • Are out of the SWH Whole Health FIDA service area for more than 6 consecutive months;
  • Become a resident of an alcohol or substance abuse services program;
  • Receive services from the Offices for People With Developmental Disabilities (OPWDD);
  • Become a resident of an Office of Mental Health (OMH);
  • Become incarcerated;
  • Need nursing home care, but are not eligible for institutional Medicaid;
  • No longer require long term care services; SWH Whole Health FIDA Plan must disenroll you from our plan if you no longer require community-based long term care services. If this happens, you can enroll in Senior Whole Health of New York's Medicaid Advantage plan under the same Medicare Advantage Plan without long term care services. You will need to complete a new enrollment application for the Medicaid Advantage Plan.

We Can Ask You to Leave the Plan

We will ask that you leave the SWH Whole Health FIDA Plan if:
  • You, your family member, or your caregiver behave in a way that prevents the plan from providing the care you need;  
  • You provide false information or behave in a deceptive or fraudulent way;
  • You fail to complete and submit any consent form or other document that is needed to obtain services for you.
You may be disenrolled if:
  • You or others in your home knowingly exhibit abusive, disruptive or uncooperative behavior to such a degree as to jeopardize the provision of care;
  • You knowingly provide false information or engage in fraudulent conduct;
  • You knowingly fail to complete and submit requested documentation.
SWH Whole Health FIDA Plan will work with you to attempt to resolve these issues. If the issues are not resolved, then SWH Whole Health FIDA Plan will notify the Enrollment Broker of request for disenrollment. The Enrollment Broker must agree with any involuntary disenrollment, and will send written notification of such to you. SWH Whole Health FIDA Plan will continue to provide or arrange for the provision of the covered services to you until the effective date of your disenrollment. Program personnel will assist you with arrangements for future services from another provider. The time frame for the effectiveness involuntary disenrollment is the same as for voluntary disenrollment.

Re-Enrollment Provisions

If you voluntarily disenroll, you will be allowed to re-enroll in the program if you meet our eligibility criteria for enrollment. If you are involuntarily disenrolled, SWH Whole Health FIDA Plan may not accept your request for enrollment.

Last Updated 10/27/2015
H8851_2016_099 Approved 12/15/2015