Members - CareAdvantage

	Appointment of Representative Form
	Enrollment Form
	Disenrollment Form
	Medicare Part D Medication Request Form
	Medicare Prescription Drug Coverage Determination
	Outpatient Authorization Form
	Inpatient Authorization Form

Important Member Information

CMS Contract - Potential Termination
The Health Plan of San Mateo (HPSM) is a Medicare Advantage Organization with a Medicare contract with the Centers for Medicare and Medicaid Services (CMS). At the end of each year, this contract is reviewed and either HPSM or CMS can decide to end it. In this situation, members will get 90 days advance notice. It is also possible for our contract to end at some other time of the year. In this situation, HPSM will try to tell members 90 days in advance, but this advance notice may be as short as 30 or fewer days if CMS must end our contract in the middle of the year.

Whenever a Medicare contract with a health plan is terminated, members will be given a special enrollment period to choose how to get Medicare through other programs. This includes choosing a Medicare Prescription Drug Plan and guaranteed issue rights to a Medigap policy.