How To Opt-Out Of PCMH+

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There are 3 ways to opt-out of the PCMH+ Program. Choose which way is best for you.

1. Phone Call

Call 1-877-858-7012, Press Option 2

Tell them you want to opt-out of PCMH Plus

What you need when you call:

  • Names of all members who wish to out-out including children 
  • Social Security Numbers
  • Client ID Number -- on HUSKY Medical ID cards, a nine digit number that starts with 00
  • They will ask you why you are opt-ing out of the program

2. Download Forms & Mail In

Download & fill out both of the following forms with your name, member ID number, and signature:

Opt-out form -- English

Opt-out form -- Spanish

Opt-out future request letter

Mail completed forms to:

HUSKY Program
PO Box 280747
East Hartford, CT 06128

3. Receive Forms In Mail

If you'd like to receive the forms in the mail with stamped, addressed envelopes to mail please supply us with your mailing address below.