Home›Documents›CCA MA Medicare Preferred (PPO) Disenrollment Form
If you request disenrollment, you must continue to get all medical care from Commonwealth Care Alliance Massachusetts (CCA) Medicare Preferred (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 MA Medicare Preferred (PPO) Disenrollment Form