Are you a Wellcare or Wellcare by ‘Ohana member who would like to disenroll from your Medicare Advantage plan? Use this form to request a disenrollment. If you request disenrollment, you must continue to get all medical care from your plan until the effective date of disenrollment. Contact Us to verify your disenrollment before you seek medical services outside of our network. We will notify you of your effective date following receipt of this form.
Note: To complete this form, you must have a valid disenrollment password. To obtain a disenrollment password, please Contact Us. One of our helpful Member Services representatives will speak with you about disenrollment and provide you with your password.
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