Potential for Contract Termination

Wellcare Prime by Absolute Total Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to members. Enrollment in Wellcare Prime depends on contract renewal.

These are the cases when Medicare and Healthy Connections Medicaid must end your membership in the plan:

If there is a break in your Medicare Part A and Part B coverage. Medicare services will end on the last day of the month that your Medicare Part A or Medicare Part B ends.
If you no longer qualify for Healthy Connections Medicaid or no longer meet Healthy Connections Medicaid eligibility requirements. Our plan is for people who qualify for both Medicare and Healthy Connections Medicaid.
If you move out of our service area.
If you are away from our service area for more than six months or you find primary residence outside of South Carolina.
If you move or take a long trip, you need to call Member Services to find out if the place you are moving or traveling to is in our service area.
If you go to jail or prison for a criminal offense.
If you are not a United States citizen or lawfully present in the United States.
If you lie about or withhold information about other insurance you have for prescription drugs.

We can ask Medicare and Healthy Connections Medicaid to end your enrollment with our plan for the following reasons:

If you give incorrect information on purpose when you are enrolling and that information affects your eligibility.
If you are constantly disruptive and make it difficult for us to provide medical care for you and other members.
If you let someone use your ID card to get medical care. If your membership ends for this reason, Medicare and/or Healthy Connections Medicaid may have your case investigated by the Inspector General. Criminal and/or civil prosecution is also possible.

Your rights upon disenrollment:

If we ask Medicare and Healthy Connections Medicaid to end your membership in our plan, we must tell you why in writing. We will also explain how you can make a complaint about our request to end your membership. See the Appeals and Grievances page for information about how to make a complaint.

If you have any questions, call Member Services at 1-855-735-4398 (TTY: 711). Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on federal holidays, you may be asked to leave a message. Your call will be returned within the next business day.