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Member Rights and Responsibilities

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We’re committed to treating members in a manner that respects their rights. We also have expectations of what our members' responsibilities are concerning their healthcare coverage. The following is our policy concerning our members' rights and responsibilities.

Rights:

  1. You have the right to be provided with information regarding member's rights and responsibilities.
  2. You have the right to be provided with information about us, our services, and practitioners providing member's care.
  3. You have the right to be treated with respect; member's provider and others caring for member will recognize his/her dignity and respect the need for privacy as much as possible.
  4. You have the right to participate in decisionā€making regarding member's health care.
  5. You have the right to have candid discussion of appropriate or medically necessary treatment options for member's conditions, regardless of cost or benefit coverage.
  6. You have the right to voice complaints, appeals, or grievances about the member's coverage through us or care provided by SWHP providers in accordance with member's Health Care Agreement.
  7. You have the right to make recommendations regarding Scott & White Health Plan's members rights and responsibilities policies.
  8. You have the right to have an advance directive such as Living Will or Durable Power of Attorney for Health Care Directive, that expresses member's choice about future care and names someone to decide if member cannot speak for himself/herself.
  9. You have the right to expect that medical information is kept confidential in accordance with member's Health Care Agreement.
  10. You have the right to select a Primary Care Physician (PCP) to coordinate your health care. It is not a requirement to select a PCP.

Responsibilities:

  1. It is your responsibility to notify us regarding any out-of-plan care.
  2. It is your responsibility to follow our instructions and rules and abide by the terms of your healthcare agreement.
  3. It is your responsibility to provide information (to the extent possible) the organization and its practitioners and providers need in order to provide care.
  4. It is your responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  5. It is your responsibility to follow plans and instructions, to the best of your ability, for care you have agreed on with your practitioner(s) and provider(s).
  6. It is your responsibility to give SWHP providers a copy of an advance directive, if one exists.
  7. It is your responsibility to advise us or SWHP providers of any dissatisfaction you may have in regard to your care while a patient, and to allow the opportunity for intervention to alter the outcome whenever possible.

July 1995 SWHP 267 (revision dates: June 2007, May 2013)