Member Rights and Responsibilities. In accordance with 42 C.F.R. §438.100, all Medicaid HMOs must maintain written policies and procedures for informing Members of their rights and responsibilities, and must notify their Members of their right to request a copy of these rights and responsibilities. The Member Handbook must include notification of Member rights and responsibilities.
Member Rights and Responsibilities. In accordance with 42 C.F.R. §438.100, MCOs must maintain written policies and procedures for informing Members of their rights and responsibilities, and must notify Members of their right to request a copy of these rights and responsibilities. The Member Handbook must include a notice that complies with Uniform Managed Care Manual Chapter 3.4.
Member Rights and Responsibilities. As a Member of the Plan, you have the following rights: You have a right to: • Detailed information about the Organization and our services. • Detailed information about our in-network providers and facilities. • Detailed information about Benefits and services that are covered under or excluded from the Plan, and all requirements that must be followed for Prior Approval. • Information about your Out-of-Pocket Costs, and an explanation of your financial responsibility for services provided to you. • Be treated with respect and recognition of your dignity and your right to privacy. We will follow applicable laws and our policies when we handle your information. • Participate with your Providers in making decisions about your health care. • Voice complaints or file Appeals with the Plan or the care provided, and to contact regulatory bodies about the Plan. • Make recommendations regarding the Plan’s Member Rights and Responsibilities policies. • Receive appropriate assistance from Health Options in a prompt, courteous, and responsible manner. • Be promptly informed of termination or changes in Benefits, services, or Network Providers. • Receive an explanation of why a Benefit is denied; the opportunity to Appeal the denial decision; the right to a second level of Appeal with the Plan; and the right to contact the Insurance Department listed on the cover of this Agreement. • Adequate access to Providers near your home or work within the Plan’s Service Area. • Receive detailed information about which services require Prior Approval and how to request Prior Approval. • Have access to a current list of Network Providers in the Plan’s network. • A candid discussion of appropriate or medically necessary treatment options for your conditions regardless of cost or benefit coverage. SAMPLE • Have a Member Representative help you follow your responsibilities and exercise your rights under the Plan. As a Member of the Plan, you have the following responsibilities (that you must do): You have a responsibility to: • Provide honest and complete information to the Plan and to your Providers in order to provide care. • Notify the Plan of any errors or omissions in your account upon discovery in a timely manner. • Choose a Network Primary Care Provider (PCP) for yourself and any Dependents. • Present your Member identification card before you receive care or, in emergency situations, after you receive care. • Pay your applicable Deductible, Coinsurance and Copayment amounts....
Member Rights and Responsibilities. As a PIC member, you have the following rights and responsibilities:
Member Rights and Responsibilities. This Section explains your rights and responsibilities under this Agreement and how you can participate on our Consumer Advisory Board. As a Member of Presbyterian Health Plan (PHP) you have specific rights and certain responsibilities. In accordance with New Mexico Administrative Code, we implement written policies and procedures regarding the rights and responsibilities of Covered Persons. Your rights and responsibilities are important and are explained in this Section and on our website at xxx.xxx.xxx.
Member Rights and Responsibilities. PacifiCare shall inform Members of their rights and responsibilities under each Managed Care Plan, provide Members with membership cards and member handbooks, distribute periodic communications to Members, process Member complaints and grievances and respond to inquiries and requests from Members regarding Managed Care Plans (collectively “Member Services”).
Member Rights and Responsibilities. The CONTRACTOR shall provide each Member with written information in the Member handbook that encompasses all the provisions in this Section 4.15.3. The CONTRACTOR must ensure that each Member is free to exercise their rights and that the exercise of these rights does not adversely affect the way the CONTRACTOR and its Contract Providers or the State treats the Member. The CONTRACTOR must have written policies regarding the Member’s and/or Representatives’ rights, including but not limited to, the guaranteed right to: Be treated with respect and with due consideration for their dignity and privacy; Receive information on available treatment options and alternatives, presented in a manner appropriate to their condition and ability to understand; Make and have honored an Advance Directive consistent with State and federal laws; Receive Covered Services in a nondiscriminatory fashion; Participate in decisions regarding their health care, including the right to refuse treatment; Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in federal regulations on the use of restraints and seclusion; Request and receive a copy of their medical records and to request that they be amended or corrected as specified in 45 C.F.R. § 164.524 and part 526; Choose a Representative to be involved as appropriate in making care decisions; Provide informed consent; Voice Grievances about the care provided by the CONTRACTOR and to make use of the Grievance, Appeal and Fair Hearing processes without fear of retaliation; Choose from among Contract Providers in accordance with the CONTRACTOR’s prior authorization requirements; Receive information about Covered Services and how to access Covered Services, and Contract Providers; Be free from harassment by the CONTRACTOR or its Contract Providers in regard to contractual disputes between the CONTRACTOR and Providers; and Participate in understanding Physical Health and Behavioral Health problems and developing mutually agreed-upon treatment goals. The CONTRACTOR shall ensure that each Member (and/or as appropriate, Representative) is free to exercise their rights and that the exercise of those rights does not adversely affect the way the CONTRACTOR or its Contract Providers treat the Member (and/or Representative). Members and/or Representatives, to the extent possible, have a responsibility to: Provide information that the CONTRACTOR and its Contract Provider...
Member Rights and Responsibilities. The Contractor shall have written policies and procedures that are designed to protect the rights of Members and enumerate the responsibilities of each Member. A written description of the rights and responsibilities of Members shall be included in the Member information materials provided to new Members. A copy of these policies and procedures shall be provided to all of the Contractor’s Network Providers to whom Members may be referred. In addition, these policies and procedures shall be provided to any Out-of-Network Provider upon request from the Provider. The Contractor’s written policies and procedures that are designed to protect the rights of Members shall include, without limitation, the right to:
Member Rights and Responsibilities. In accordance with 42 C.F.R. § 438.100, the Contractor shall have written policies and procedures regarding Member rights and shall ensure compliance of its staff and affiliated Providers with any applicable Federal and State laws that pertain to Member rights. Policies and procedures shall include compliance with:
Member Rights and Responsibilities. 5.01 Pursuant to Act 379 of the Public Act of 1965, the Board hereby agrees that every employee of the Board will have the right to freely organize, join, and support the Association for the purpose of engaging in collective negotiations and other lawful activities.
