Members rights and responsibilities

You have the right as a healthcare Plan member to:

Be treated with respect, dignity and privacy;

Have access to medically necessary and appropriate covered healthcare services, including emergency services, 24 hours a day, seven (7) days a week;

Be informed of your health problems and to receive information regarding treatment alternatives and their risk in order to make an informed choice about your care regardless of whether the health Plan pays for treatment;

Participate with your healthcare provider in decisions about your treatment;

Give your healthcare provider a healthcare directive or a living will (a list of instructions about health treatments to be carried out in the event of incapacity or the inability to make your own health decisions);

Refuse treatment;

Privacy of medical and financial records maintained by the healthcare Plan, the claims administrator and its healthcare providers in accordance with existing law;

Receive information about the healthcare Plan, its services, its providers, and your rights and responsibilities;

Make recommendations regarding these rights and responsibilities policies;

Have a resource at the healthcare Plan, the claims administrator or at the clinic that you can contact with any concerns about services;

File an appeal with the claims administrator and receive a prompt and fair review;

and Initiate a legal proceeding when experiencing a problem with the healthcare Plan or its providers.

You have the responsibility as a healthcare Plan member to:

Know your healthcare Plan benefits and requirements;

Provide, as much as you can, information that the healthcare Plan, the claims administrator and its providers need in order to care for you;

Understand your health and work with your provider to set mutually agreed upon treatment goals;

Follow the treatment plan that your healthcare provider recommends or to discuss with your provider why you are unable to follow the treatment plan;

Provide proof of health insurance coverage when you receive services and to update the clinic with any personal changes;

Pay copayments at the time of service and to promptly pay deductibles, coinsurance and, if applicable, charges for services that are not covered.