Kalos Health Gold Plus is an insurance product sold through licensed and appointed agents. The agent will complete a “Scope of Appointment” form and detail what would be discussed during the sales presentation. After that, the agent will go through the elements of the plan with specific focus on eligibility, suitability, service area, covered services and cost sharing.
Individuals who want to enroll after the presentation must complete an Enrollment Application and return it to the agent for processing.
Once the enrollment application is processed, the new member will receive a Welcome Packet with a confirmation letter and their plan ID card. They will also receive the plans’ Evidence of Coverage, along with a Provider Directory, Pharmacy Directory, and Formulary Notice document.
Individuals do not have to wait until the Medicare Open Enrollment Period (OEP). People who are eligible for a dual plan can enroll at any time during the year.
Coverage is generally effective the first of the following month, but not when enrollment is completed during Medicare Annual Enrollment Period (AEP):
- AEP enrollment from October 15 through December 7, 2019 will become effective January 1, 2020.
Medicare Advantage Ending My Membership (Disenrollment)
Ending your membership in Kalos Health Gold Plus may be voluntary (your own choice) or involuntary (not your own choice):
You might leave our plan because you have decided that you want to leave.
- You can end your membership in the plan at any time.
- The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing.
- There are also limited situations where you do not choose to leave, but we are required to end your membership.
When can you end your membership in our Kalos Health Gold Plus?
- You can end your membership during the Annual Enrollment Period (October 15 through December 7).
- You can end your membership during the annual Medicare Advantage Disenrollment Period (January 1 through February 14), but your choices are more limited.
- In certain situations, you can end your membership during a Special Enrollment Period.
For more information about ending your membership, see Chapter 10 Section 2 of your Evidence of Coverage.
Contact us at 1-800-399-1954 (TTY: 711) Hours of Operation: Monday – Friday, 8am – 8pm
Kalos Health Gold Plus is a Health Maintenance Organization (HMO) Special Needs Plan (SNP) with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health. Enrollment in Kalos Health Gold Plus depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. You must continue to pay your Medicare Part B premium (unless your part B premium is paid for you by Medicaid or another third party).
Last Updated 01-02-2019