Certain health plans that were in effect prior to March 23, 2010 may be "grandfathered health plans" under the Patient Protection and Affordable Care Act. If your plan is grandfathered, then your plan will include some consumer protections from the Affordable Care Act, but may not include other protections that apply to non-grandfathered health plans. If your plan is a grandfathered health plan, notice indicating that fact will be contained in your Certificate Booklet or your group's summary plan description.
As a member, you have rights and responsibilities when receiving health care. As your health care partner, we want to make sure your rights are respected while providing your health benefits. That means giving you access to our network of health care providers and the information you need to make the best decisions for your health. As a member, you should also take an active role in your care.
You have the right to:
- Speak freely and privately with your health care providers about all health care options and treatment needed for your condition, no matter what the cost or whether it is covered under your plan.
- Work with your doctors to make choices about your health care.
- Be treated with respect and dignity.
- Expect us to keep your personal health information private by following our privacy policies, and state and Federal laws.
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Get the information you need to help make sure you get the most from your health plan, and share your feedback. This includes information on:
- our company and services.
- our network of health care providers.
- your rights and responsibilities.
- the rules of your health plan.
- the way your health plan works.
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Make a complaint or file an appeal about:
- your health plan and any care you receive.
- any covered service or benefit decision that your health plan makes.
- Say no to care, for any condition, sickness or disease, without it having an effect on any care you may get in the future. This includes asking your doctor to tell you how that may affect your health now and in the future.
- Get the most up-to-date information from a health care provider about the cause of your illness, your treatment and what may result from it. You can ask for help if you do not understand this information.
You have the responsibility to:
- Read all information about your health benefits and ask for help if you have questions.
- Follow all health plan rules and policies.
- Choose an In-network primary care physician, also called a PCP, if your health plan requires it.
- Treat all doctors, health care providers and staff with respect.
- Keep all scheduled appointments. Call your health care provider’s office if you may be late or need to cancel.
- Understand your health problems as well as you can and work with your health care providers to make a treatment plan that you all agree on.
- Inform your health care providers if you don’t understand any type of care you’re getting or what they want you to do as part of your care plan.
- Follow the health care plan that you have agreed on with your health care providers.
- Give us, your doctors and other health care providers the information needed to help you get the best possible care and all the benefits you are eligible for under your health plan. This may include information about other health insurance benefits you have along with your coverage with us.
- Inform Member Services if you have any changes to your name, address or family members covered under your plan.
If you would like more information, have comments, log in to contact us or call the Member Services number on your ID card.
We want to provide high quality benefits and customer service to our members. Benefits and coverage for services given under the plan are overseen by your Certificate of Coverage, Member Handbook or Schedule of Benefits and not by this Member Rights and Responsibilities statement.
Reviewed 2/2018
