Member Rights

• Choice of a qualified physician and hospital. (Selection choice may be limited by the provider's patient caseload and their willingness to accept payment from Care Improvement Plus.)
• Candid discussion of appropriate or medically necessary treatment options, regardless of cost or benefit coverage.
• Timely access to a personal care physician or specialist when medically necessary.
• Receive emergency services when, as a prudent layperson, acting reasonably would have believed that an emergency medical condition existed and payment will not be withheld in cases where members seek emergency services.
• Actively participate in decisions regarding health and treatment options.
• Receive urgently needed services when traveling outside the Plan's service area or in the Plan's service area when unusual or extenuating circumstances prevent a Member from obtaining care from his/her personal care physician.
• Be treated with dignity and respect and have the right to privacy recognized.
• Exercise these rights regardless of race, physical or mental disability, ethnicity, gender, sexual orientation, creed, age, religion or national origin, cultural or educational background, economic or health status, English proficiency, reading skills, mental condition or source of payment for health care And to expect that both the Plan and contracting medical providers will uphold these rights.
• Confidential treatment of all communications and records pertaining to care. Members have the right to access medical records. The Plan must provide timely access to records and any information that pertains to them (there may be a fee charged for making copies). Written permission from Members or Member's authorized representatives shall be obtained before medical records can be made available to any person not directly concerned with the Member's care or responsible for making payments for the cost of such care.
• Extend rights to any person who may have legal responsibility to make decision on a Member's behalf regarding medical care.
• Refuse treatment or leave a medical facility, even against the advice of physicians (providing the Member accepts responsibility and the consequences of the decision).
• Complete an advance directive, living will or other directive and provide copies to appropriate people and medical providers.
• Receive information about Care Improvement Plus and covered services.
• Know the names and qualifications of physicians and health care professionals involved in medical treatment.
• Receive information about an illness, the course of treatment and prospects for recovery in understandable terms.
• Receive information regarding how medical treatment decisions are made by contracting medical providers, including payment structure.
• Receive information about medications including what they are, how to take them and possible side affects.
• Receive as much information about any proposed treatment or procedure as needed in order to give informed consent or to refuse a course of treatment. Except in cases of emergency services, this information shall include a description of the procedure or treatment description, the medically significant risks involved, any alternate course of treatment or non-treatment and the risks involved in each, and he name of the person who will carry out the procedure or treatment.
• Reasonable continuity of care and to know in advance the time and location of an appointment, as well as the physician providing the care.
• Be advised if a physician proposes to engage in experimentation affecting care or treatment. Members have the right to refuse to participate in such research projects.
• Be informed of continuing health care requirements following discharge from inpatient or outpatient facilities.
• Examine and receive an explanation of any bills for non-covered services, regardless of payment source.
• Make complaints and appeals without discrimination and expect problems to be fairly examined and appropriately addressed.
• Responsiveness to reasonable requests made for services.

Member Responsibilities

• Provide physicians or other care providers the information needed in order to provide care.
• Do their part to improve health conditions by following treatment plans, instructions and care agreed to with physicians.
• Behave in a manner that supports the care provided to other patients and the general functioning of the facility.
• Accept the financial responsibility associated with services received while under the care of a physician or while a patient in a facility.
• Review information regarding covered services, policies and procedures as stated in the Member Agreement and Disclosure Information.
• Ask questions of personal care physician or health plan staff.