Member and Plan Rights and Responsibilities upon Disenrollment

  • If you are a member of PICA and would like to disenroll from the Plan: you should contact PICA Customer Services first in order to receive a complete orientation of the disenrollment process. To disenroll, you must send a letter to PICA requesting disenrollment from the Plan and stating your reason for disenrollment. You can ask a representative in PICA Member Services for PICA's Disenrollment Letter or you may send your own paper letter requesting disenrollment. 
Important: whether you submit your own disenrollment request letter or ask PICA for its Disenrollment Letter, either letter has to be signed by PICA's member or his/her legal tutor (if you have a legal tutor, the disenrollment letter must indicate that the person signing the letter is your legal tutor and/or attach the power of attorney).

You may submit your disenrollment letter by mailing it or faxing it to the address/fax number below. 

  • Voluntary Enrollment Cancellation: if you enrolled in PICA but want to cancel your enrollment in the Plan, you may request cancellation of enrollment by calling PICA's Member Services Center at 1-866-990-7422. TTY/TDD users should call 1-866-992-7422. PICA Member Services call center hours are 8:00AM - 8:00PM, 7 days a week. You may also mail or fax an enrollment cancellation request to the address/fax number below (you can ask a representative in PICA Member Services for PICA's Cancellation of Enrollment Letter or you may send your own paper letter requesting cancellation of enrollment).

If you were enrolled in another plan before enrolling in PICA, you may appear on the other plan's records as disenrolled. If your intent was not to disenroll from that other plan, you need to cancel your enrollment in PICA and notify the other plan that you enrolled in PICA but cancelled PICA's enrollment. The other plan may request a copy of the Cancellation of Enrollment Letter for its records.

All correspondence should be mailed to:

PICA

Enrollment Department

P.O. Box 11320

San Juan, PR 00922

You may also fax your request to: (787) 759-7776.

Important Note: if you do not maintain Medicare prescription drug coverage or other creditable prescription drug coverage, you may have to pay a late enrollment penalty if you enroll in Medicare prescription drug coverage in the future.

Last Updated: 1/7/2014

 

PICA (PDP) is a PDP plan with a Medicare contract. Enrollment in PICA (PDP) depends on contract renewal. PICA's plans are available to all Medicare beneficiaries with Medicare Parts A, B or both that reside in the service area, Puerto Rico. The benefit information provided is a brief summary, not a complete description of benefits. In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1st of each year. Members may enroll in the plan only during specific times of the year. You must continue to pay your Medicare Part B premium. This information is available for free in other languages. Please contact our customer service number at 1-866-990-PICA (7422) for additional information. TTY/TDD users should call 1-866-992-PICA (7422). You may also contact customer service for additional information on benefits and specific enrollment periods throughout the year. PICA Member Services (customer service) call center hours are 8:00AM - 8:00PM, 7 days a week.

Servicio de Interpretes Multilenguaje - Esta información está disponible libre de costo en otros idiomas. Comuníquese con nuestro número de servicio al cliente al 1-866-990-PICA (7422) para información adicional. Usuarios de TTY/TDD deben comunicarse al 1-866-992-PICA (7422). El horario de servicio del cuadro telefónico es 8:00AM - 8:00PM, los 7 días de la semana.

Copyright © 2014 PICA - S5775_1403_1 CMS Approved

Last Updated 5/7/2014

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