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Your rights
Your rights
As a member of this plan, you have many rights you can count on. These include your right to:
- Be treated with courtesy, consideration, respect, dignity and need for privacy.
- Get info about the plan, its policies and procedures, and its services.
- Be able to communicate and be understood, with the assistance of a translator if needed.
- Choose a primary care physician (PCP) in your plan’s network. And make a plan for your care.
- Refuse care from any provider.
- Know all of your treatment options.
- File a grievance about your plan, provider or the way you got care.
- Appeal decisions made by the plan.
- Make advance directives.
- Get access to your medical records.
- Be free from physical restraints, isolation and neglect.
- Refuse treatment. And understand the consequences.
- Get care that will improve your quality of life.
- Have access to care 24/7 for emergency and urgent care.
- Choose a specialist if you need one.
- Get an updated contact list of providers in our network.
- Get a referral for providers who treat chronic issues.
- Be free from balance billing by providers for medically necessary services authorized by the plan. You may be asked to pay a copay.
- Get a second opinion.
- Be notified when there is a change in your benefits.
- Share your thoughts about our rights and responsibilities policy.
Your responsibilities
Your responsibilities
As a member of this plan, you are responsible for:
- Bringing your member ID card to appointments.
- Knowing the name of your PCP.
- Knowing about your plan and the rules for getting care.
- Telling the plan when you make changes to your address, phone number or other personal info.
- Understanding your health problems. And actively taking part in your treatment.
- Being respectful to the health care providers giving you care.
- Scheduling your appointments and being on time. And calling your provider if you can’t make your appointment.
- Giving your health care providers all the info that they need.
- Telling the plan about your questions, concerns and issues.
- Asking for more info if you don’t understand your condition.
- Asking your health care providers for more info on other treatment options. This includes details on the benefits, potential risks and costs.
- Following your health care providers’ advice.
- Telling us about any other insurance that you have.
- Telling us if you’re applying for other health insurance.
- Bringing shot records to appointments for children under 18.
- Giving your providers a copy of your living will and/or health care proxy.
- Keeping track of the copays that you pay.
- Following the steps to file a grievance about your plan, provider or the way you got care.
Call us
You can find out more about your rights and responsibilities by contacting Member Services. Just call 1-855-242-0802 (TTY: 711) We’re here for you 24 hours a day, 7 days a week.