Your Rights

As a partner with us, your doctor, and other providers, you or your legal designee have the right to:

• Get information about us, our services, your providers, and your rights and responsibilities as a member.
• Be treated with dignity and respect.
• Privacy and confidential treatment of all personal information.
• Participate with providers in making decisions about your care.
• An open discussion of all treatment options for your condition, regardless of the cost of care or benefit coverage.
• Voice complaints about us or your care. Appeal any unfavorable decisions by following the appeal and grievance process.
• Make recommendations regarding our member rights and responsibilities policy.
• Ask about any healthcare concerns, request medical advice or get more information about treatment in order to make an informed decision or refuse a course of treatment.
• Understand your condition, health status, and the drugs prescribed for you – what they are, what they are for, how to take them properly, and possible side effects.
• Know how your plan operates. Get plan materials.
• See your PCP and get referrals to specialists when medically necessary or urgent.
• Use emergency services when you, as a prudent layperson acting reasonably, believe that an emergency medical condition exists.
• Information about provider payment agreements, as well as explanations of benefits or claims processing determinations.
• Expect problems to be fairly examined and addressed.

You are entitled to exercise these rights regardless of race, national origin, gender, sexual orientation, marital status, or cultural, economic, educational, or religious background.

Your Responsibilities

You or your legal designee has the responsibility to:

• Give information, to the extent possible, that:

o   Your providers need in order to provide care; and

o   We need in order to determine payment for that care.

• Follow care plans that you and your providers have agreed to.
• Understand your health problems and help create treatment goals, as much as possible.
• Show your member ID card when getting medical services.
• Be on time for all appointments. Tell your doctor’s office as soon as possible if you need to cancel or reschedule.
• Tell your PCP and us within 48 hours, or as soon as possible, if you:

o   Are hospitalized;

o   Get emergency care; or

o   Get out-of-area Urgent Care.

• Pay your cost-share when you have services.
• Understand covered services, policies and procedures. Read your plan materials.

Ask questions if you do not understand your benefits or care options.