Do you want to disenroll from your Wellcare plan? We're sorry to see you go!

You can use the Disenrollment Form to disenroll from your Wellcare plan. Note that 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 the effective date of your disenrollment from the plan following receipt of this form.

Instructions

You may type to complete the Medicare Disenrollment Form (PDF), or PDP Disenrollment Form (PDF). To do so, download and complete the form on your computer using a program like Adobe Acrobat Reader. Your form must have a completed signature in order to be considered complete. You can download a free version of Adobe Reader at get.adobe.com.

Please mail or fax your completed form. 

For more information on disenrollment, including your rights and responsibilities upon disenrollment, refer to the following chapters in your Evidence of Coverage:

• Medicare Members: Chapter 8 on Member Rights and Responsibilities and Chapter 10 on Disenrollment
• Prescription Drug Plan Members: Chapter 6 on Member Rights and Responsibilities and Chapter 8 on Disenrollment