HMO Member Rights and Responsibilities

En Español

As an HMO member, you have important rights related to the health care you receive. You are entitled to these rights without regard to your race, ethnic backgrnd, national orign, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment. You also have responsibilities to be an informed patient and HMO member. By learning your rights and responsibilities, you will maximize your HMO coverage. 

Member Rights

You have the right to:

  • Participate in decisions about your health care and treatment plan.
  • Voice your opinion about the managed care organization, the care provided and to recommend changes in policies and services by contacting your health plan’s member services department.
  • Be provided with information about the managed care organization and its services.
  • Be treated with respect and dignity.
  • Receive from your health care provider complete information about your diagnosis, any proposed procedure or treatment alternative, including non-treatment, in order to give informed consent.
  • Refuse any procedure or treatment if you so desire and to the extent permitted by law, be told what effect this may have on your health.
  • Receive full consideration of privacy of confidentiality with regard to all information and records about your care.
  • Know the cost (co-payment, deductible, coinsurance) of care and treatment and receive an explanation of your financial obligation when required.
  • Change primary care physicians by contacting your health plan’s member services department.
  • Have 24-hour access to your primary Care physician or a covering physician. If you are out-of-area or traveling, receive emergency care, if needed.
  • Be informed of the names, specialties and qualifications of the doctors.
  • Be informed of the grievance procedures.
  • Receive prompt and reasonable responses to questions and requests.
  • Members who are not fully able to participate in treatment decisions have the right to be represented by parents, guardians, family members or other conservator.

Member Responsibilities

  • Know the benefits and exclusions of your coverage.
  • Provide your health care provider with complete and accurate health information.
  • Follow the treatment plan agreed upon by you and your health care provider.
  • Contact your primary care physician for any care needed after-hours.
  • Know how to access health care services in routine, urgent and emergency situations.
  • Contact your health plan member services department immediately for any questions and assistance.