As a member of an HMO, you have rights and responsibilities.
Member responsibilities: view PDF
Each member has the right to:
- Exercise your rights without discrimination.
- Be provided with comprehensive information about the medical group, its services, providers, their qualifications, and the health care service delivery process.
- Be informed of emergency and non-emergency coverage and cost of care, and receive an explanation of financial obligations as appropriate prior to incurring the expense (co-payments, deductible, and co-insurance).
- Be provided information on how to obtain care after normal business hours and how to obtain emergency care including when to access emergency care or use 911.
- Be informed of the name and qualifications of a Primary Care Physician or other specialist physicians coordinating your care.
- Have 24-hour access to your Primary Care Physician (or their covering physician).
- Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment and non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable, in order to give informed consent or to refuse that course of treatment.
- Candidly discuss appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
- Actively be involved with doctors and other health care professionals in making decisions regarding your health care.
- Be treated with courtesy, respect and dignity; receive considerate and respectful care with full consideration of privacy.
- Be afforded the opportunity to consent or deny the release of identifiable medical or other information except when such release is required by law.
- Express opinions or concerns to the medical group about the care provided (contact Member Services).
- Be informed of the member complaint/grievance and appeal process, as well as the ability to express a complaint in writing or by phone.
- Be informed of the availability of physicians, termination of a physician, or practice site. Receive assistance in selecting a new Primary Care or Specialty Physician.
- Change your Primary Care Physician by contacting your health plan.
- Receive reasonable continuity and continuation of care and be given timely and sensible answers to questions and requests made for service, care, covered benefits, non-covered services and payment.
- Be informed of continuing health care requirements following office visits, treatments, procedures, and hospitalization.
- Be represented by parents, guardians, family members or other conservators when you are unable to fully participate in your treatment decisions.
- Be informed and make recommendations to the Member Rights and Responsibilities.