Home›Documents›CCA Health RI Medicare Value (PPO) Disenrollment Form (2024)
If you request disenrollment, you must continue to get all medical care from CCA Health Rhode Island (CCA Health) Medicare Value (PPO) 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 your effective date after we get this form from you.
CCA Health RI Medicare Value (PPO) Disenrollment Form (2024)