Disenrollment Form - Wellcare 2026

1. Click ‘Get Form’ to open the Disenrollment Form in the editor.
2. Begin by entering your Last Name, First Name, and Middle Initial. Ensure accuracy as this information is crucial for identification.
3. Fill in your Wellcare Subscriber ID Number and Medicare Number. These identifiers help process your disenrollment efficiently.
4. Provide your Date of Birth, Sex, Home Phone Number, and Mobile Phone Number. This contact information is essential for any follow-up communications.
5. Complete your Permanent Residence Address. Note that P.O. Boxes are not allowed here; ensure you provide a physical address.
6. If applicable, fill in a different Mailing Address. This can be a P.O. Box if needed.
7. Select the reason for disenrollment by checking the appropriate box and provide any necessary details in the space provided.
8. Finally, sign and date the form at the bottom. If someone else is signing on your behalf, ensure they provide their details as well.

Start using our platform today to complete your Disenrollment Form quickly and easily!