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National Home Members Member Information Member Rights

Member Rights

Care Improvement Plus Members have the right to:
  • 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

Care Improvement Plus Members have the responsibility to:
  • 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.

This page was last updated on: 6/28/2013 3:20:06 PM

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Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next.

Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts. The health providers in our network can change at any time.

To be eligible for a Care Improvement Plus Regional PPO plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, or Texas and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Local PPO plan you must be a Medicare beneficiary living in select counties of: Arkansas, Georgia, Illinois, Indiana, Iowa, Missouri, Nebraska, New Mexico, North Carolina, South Carolina, Texas or Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure and/or, cardiovascular disorder. This plan is available to anyone having a qualifying chronic care condition. Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, cardiovascular disorder or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

To be eligible for a Care Improvement Plus Dual Advantage Plan, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing. This plan is available to anyone who has both medical assistance from the state and from Medicare. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, co-insurance and deductibles may vary based on the level of extra help you receive. Please contact the plan for further details.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office, or call Social Security at 1– 800–772–1213.TTY users should call 1–800–325–0778. You can also apply for Extra Help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for Extra Help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

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