There are a few times when disenrollment from Nebraska Total Care is possible. This means you can change health plans. Those are:
- During the first 90 days that you have the plan
- During the enrollment period at the end of every year
- If losing your Medicaid makes you miss open enrollment
Disenrolling For Cause at Any Time
You can ask to disenroll at other times for these reasons:
- You move out of Nebraska
- The contract between Nebraska Total Care and the State of Nebraska ends
- Nebraska Total Care does not, because of moral or religious objections, cover the service you seek
- You need two or more services at the same time and Nebraska Total Care does not have those services available. Your PCP and another provider decide that getting those services separately would cause you risk.
- Other reasons, including but not limited to:
- poor quality of care,
- lack of access to services that are covered by the plan
- lack of access to providers who have experience with your healthcare needs
How to Disenroll
You may ask to disenroll (with or without cause) in writing or by calling the Enrollment Broker. The phone number is 1-888-255-2605 (Relay 711). They are available Monday through Friday from 7:00 a.m. to 7:00 p.m., Central Time.
If you request disenrollment with cause, you must give the reason. The reason must be on the list of “for cause” reasons above. If your request to change health plans is denied, you may appeal by using the State Fair Hearing process. There is more information about State Fair Hearing in the appeals section of this handbook.
Involuntary Disenrollment for Cause
- Nebraska Total Care may ask for a member to be disenrolled. We would notify the Enrollment Broker in writing. Nebraska Total Care may ask for disenrollment at any time if:
- The member allows someone else to use their Nebraska Total Care ID card
- The member’s use of services is fraudulent or abusive
- The member’s behavior is so disruptive, threatening or uncooperative that behavior makes us unable to cover or provide services. This does not include behavior that is because of special needs, or physical or behavioral health problems.
- The member moves out of Nebraska
Nebraska Total Care may not ask for disenrollment because:
- The member has a pre-existing medical condition
- The member has a change in health status
- The member uses medical services
- The member has diminished medical capacity
- The member refuses medical care or diagnostic testing
- The member completes a grievance or appeal
- The member asks to change providers