MEMBERS’ RIGHTS AND RESPONSIBILITES STATEMENT
Statement of Members’ Rights
o Members have the right to be treated with dignity and respect.
o Members have the right to fair treatment, regardless of their race, religion, gender, ethnicity, sexual orientation, age, or disability.
o Members have the right to have their treatment and other member information kept private. Only where permitted by law, may records be released without member permission.
o Members have the right to easily access timely care in a timely fashion.
o Members have the right to know about their treatment choices. This is regardless of cost or coverage by the member’s benefit plan.
o Members have the right to share in developing their plan of care.
o Members have the right to information in a language they can understand.
o Members have the right to have clear explanation of their condition and treatment options.
o Members have the right to information about insurance providers, its practitioners, services, and role in the treatment process.
o Members have the right to know about clinical guidelines used in providing and managing their care.
o Members have the right to ask their provider about their work history and training.
o Members have the right to give input on the Members’ Right and Responsibilities policy.
o Members have a right to know about advocacy and community groups and prevention services.
o Members have a right to freely file a complaint or appeal and to learn how to do so.
o Members have the right to know of their rights and responsibilities in the treatment process.
o Members have the right to receive services that will not jeopardize their employment.
o Members have the right to list certain preferences in a provider.
Statement of Members’ Responsibilities
· Members have the responsibility to treat those giving them care with dignity and respect.
· Members have the responsibility to give providers information they need. This is so providers can deliver the best possible care.
· Members have the responsibility to follow the treatment plan. The plan of care is to be agreed upon by the member and the provider.
· Members have the responsibility to follow the agreed upon medication plan.
· Members have the responsibility to tell their providers and primary care physician about medication changes, including medications given to them by others.
· Members have the responsibility to keep their appointments. Members should call their providers as soon as they know they need to cancel a visit.
· Members have the responsibility to let their providers know when the treatment plan isn’t working.
· Members have the responsibility to report abuse and fraud.
· Members have the responsibility to openly report concerns about the quality of care they receive.
My signature below shows that I have been informed of my rights and responsibilities, and I understand this information.