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If you request disenrollment, you must continue to get all medical care from Mode Health HMO until the effective date of disenrollment. Contact us to verify your disenrollment before you seek medical

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What is if you request disenrollment?

If you request disenrollment, it means you are asking to be removed or withdrawn from a specific program or service.

Who is required to file if you request disenrollment?

You are required to file for disenrollment if you no longer wish to participate in the program or service.

How to fill out if you request disenrollment?

You can fill out a disenrollment form provided by the program or service provider.

What is the purpose of if you request disenrollment?

The purpose of requesting disenrollment is to officially terminate your participation in the program or service.

What information must be reported on if you request disenrollment?

You must provide your personal information, reason for disenrollment, and any required documentation.

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