Imperial Health Plan of California Member Rights

 

Imperial Health Plan of California (HMO) (HMO SNP) is dedicated to ensuring that their members have a complete understanding of their Medicare rights, protections and responsibilities as an Imperial Health Plan member. These rights and responsibilities are for all members, regardless of race, sex, culture, economic, educational or religious background. Refer to Chapter 8: Rights and Responsibilities in your Evidence of Coverage.

These rights and responsibilities shall encompass every eligible Imperial Health Plan member.

  • To be treated with dignity, respect, and fairness at all times. Imperial Health Plan will obey laws that protect the members from discrimination or unfair treatment. Imperial Health Plan does not discriminate based on a person’s race, disability, religion, sex, health, ethnicity, creed (beliefs), age, or national origin.
  • To the privacy of their medical records and personal health information. To have health and medical records, as well as any other information, treated with confidentiality, regardless of the format of that information (i.e., spoken communications, written materials, electronic records, or facsimiles). As well as to have access to their medical records and controlling how their health information is used in accordance with law.
  • To see network providers, get covered services within a reasonable amount of time. The right to choose a primary care provider (PCP) within the network. Timely access to specialty providers with a referral, the right to a women’s health specialist within the network without a referral. To get prescriptions filled or refilled at any network pharmacy without long delays.
  • To receive information on available treatment options (including the option of no treatment) or alternative courses of care in a way that they can understand. Including the right to a detailed explanation from Imperial Health Plan if they believe a provider has denied care that they believe they are entitled to (or continue to) receive. They may refuse treatment, leave a hospital or other facility against medical advice not to leave and to stop taking medication.
  • To use an advance directive (such as a living will or a power of attorney). To choose a representative to facilitate care of treatment decisions, including withholding resuscitative services or to forego or withdraw life-sustaining treatment, when they are unable to do so.
  • The right to get information from Imperial Health Plan about our plan. This includes information about our financial condition, and how our plan compares to other health plans.
  • To receive information in other formats. The right to get questions answered. Imperial Health Plan has individuals and translation services available to answer questions, and make information accessible to/from members with Limited English Proficiency (LEP).
  • To get information from Imperial Health Plan about our network pharmacies, providers and their qualifications and how we pay our doctors.
  • To get information about their prescriptions drugs, Part C medical care or services, and costs. The right to an explanation from Imperial Health Plan about any prescription drug or medical service not covered by the plan.
  • To make complaints and obtain a prompt resolution of issues (including complaints, grievances or appeals) relating to authorization, coverage, or payment of services.
  • To get more information about their rights.

Imperial Health Plan Members have the responsibility:

  • To become familiar with their coverage and the rules that must be followed to get care as a member.
  • To use all of their insurance coverage. If the member has additional health insurance coverage or prescription drug coverage, besides Imperial Health Plan, it must be used in combination with their Imperial Health Plan coverage to pay for their health care or prescription drug expenses.
  • To notify providers when seeking care (unless it is an emergency) that you are enrolled in our plan and must present their Imperial Health Plan member identification card to the provider.
  • To give doctors and other health care providers the information they need to provide health care and following the treatment plans and instructions that the member and provider agreed upon.
  • To act in a way that supports the care given to other patients and helps the smooth operation of their doctor’s office, hospitals, and other offices.
  • To pay any applicable copayment, deductible, co-insurance or charge for non-covered services when requested by their Imperial Health Plan provider, including PCP, specialists, vision provider, dental provider etc.
  • To notify us if they move. The member has the responsibility to notify Imperial Health Plan when the member moves within the Imperial Health Plan service are, so that we may keep their membership record up-to-date. If the member moves out of the service area, the member may not remain a plan member.
  • To let us know if they have any questions, concerns, or suggestions.