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Disenrollment

When can you end your membership in our plan?

You may end your membership in our plan only during certain times of the year, known as enrollment periods. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. In certain situations, you may also be eligible to leave the plan at other times of the year.

You can disenroll by:

  1. Completing the Disenrollment Form or requesting the Disenrollment form from Imperial Health Plan’s Member Service Department at 1-800-838-8271, (TTY/TDD: 711). Once received, you can send it via email to: Enrollmentunit@imperialhealthplan.com, fax it to 1-626-380-9066 or mail it to PO BOX 60874, Pasadena, CA 91116.
  2. Write a letter to the plan requesting to disenroll via email to: Enrollmentunit@imperialhealthplan.com, fax it to 1-626-380-9066 or mail it to PO BOX 60874, Pasadena, CA 91116.
  3. Enroll in another plan (during a valid enrollment period)
  4. Call 1-800-MEDICARE and request to disenroll

Disenrollment Form

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