YOUR RIGHTS AND RESPONSIBILITIES

As a Plan enrollee, you have rights and responsibilities. If the enrollee is a child, the rights, responsibility and legal responsibility are given to the child’s parents or legal guardian.

You Have These Rights:
You have the right to be treated with courtesy, respect, and consideration of your dignity and privacy.

You have a right to covered health care services regardless of your race, ethnicity, country of birth, language, religion, gender, sexual orientation, medical history or age.

You have a right to receive health services in a timely manner that is considerate of your culture and your personal needs.

You have a right to language services at no cost to you

• if you do not speak English
• if you have hearing problems
• if you have trouble reading

You have the right to ask your PCP to give you health information in a manner you can understand. Integral Quality Care allows you to choose your own primary care physician (PCP).

You have a right to receive information from Integral Quality Care about your benefits in a format and a language that you can understand. If there are changes to your plan, we will let you know in writing at least 30 days before the change.

You have a right to participate in all decisions about your health care.

You have a right to know about all your treatment choices and the risks that come with those choices

You have a right to ask questions and receive full information about your medical procedures and who will do them

You have a right to a second opinion at no extra cost to you.

You have a right to know if a treatment is considered experimental and to say no to experimental treatments.

You have a right to refuse treatment or to stop taking medications. You do not have to follow a treatment plan to be eligible for medical care.

You have a right to have a friend or family member help you with health care decisions when needed.

You have a right to have a friend or family member with you for treatments or procedures.

You have a right to have another woman in the room for breast and pelvic exams.

You have the right to talk to health care professionals and case managers in private.

You have a right to be free from any form of restraint or seclusion that is used as a means of force, discipline, revenge or convenience.

You have the right to keep your health information private. We will only share your health information with another person after you give us permission to share with that person.

You have a right to see and make a copy of your medical records.

You have a right to make a correction to your medical records if you see an error.

You have a right to know how your health information is used.

If you will owe money for any part of your treatment, you have a right to know before treatment what the charges will be.

If you owe money for a treatment that you have already had, you have a right to receive a detailed bill.

You have a right to know if financial assistance is available.

If you have a complaint about your health care, or about Integral Quality Care, you have the right to report these concerns to us. This will not affect your future health care.

You, or your provider, have the right to file a complaint, a grievance or an appeal asking us to review our decision.

You have the right to have our response to this complaint, grievance or appeal in as timely a manner as your health condition demands.

You will never be denied covered health services just because you exercised any of the rights listed here.

You Have These Responsibilities:
We expect you to know the name of your primary doctor and your case manager if you have one.

We expect you to know and follow the rules for getting your health care services.

We expect you tell us when you have a concern or a problem.

We expect you to tell us when you have other insurance, have Medicare, or are applying for other insurance.

We expect you to show your ID card to providers when you get services.

We expect you to protect your ID card: do not allow anyone else to use your card or any of the information on your card. Do not allow anyone (even a provider) to use your card to bill for services you did not receive.

We expect you to respect the health care professionals who are giving you care.

We expect you to give your health care providers all the information they need to take care of you.

We expect you to ask for more information if you do not understand your treatment or health condition.

We expect you to make appointments during office hours and be on time.

We expect you to call the doctor’s office 24 hours before an appointment if you need to cancel.