Member Rights and Responsibilities

1. Receive information about your rights and responsibilities as a member in terms you can understand.
2. Have access to culturally and linguistically appropriate language interpretation services free of charge.
3. Always be treated with respect and recognition of your dignity and right to privacy.
4. Expect privacy of your personal health information (PHI).
5. Choose and change a primary care physician (PCP) from a list of network physicians or practitioners.
6. Information on all treatment options that you may have in terms you can understand so that you can give informed consent before treatment begins.
7. Refuse treatment to the extent permitted by law and be informed of the consequences of your refusal.
8. Openly discuss appropriate or medically necessary treatment options regardless of cost or benefit coverage.
9. Participate with providers in making decisions involving your healthcare.
10. Voice concerns or complaints about your healthcare by contacting PHP Customer Service or submitting a formal, written grievance through PHP’s appeals process.
11. Be given information about PHP, its services, and the healthcare providers in its network, including their qualifications.
12. Make suggestions regarding PHP’s member rights and responsibilities policies.
13. Receive covered benefits consistent with your plan summary and state and federal regulations.

Your Responsibilities

PHP members have the responsibility to:

1. Select or be assigned a primary care physician from PHP’s list of network healthcare providers if required by your plan and notify PHP when you have made a change.
2. Be aware that all hospitalizations must be approved in advance by PHP, except in emergencies or for urgently needed health services.
3. Use emergency department services only for the treatment of a serious or life-threatening medical condition.
4. Always present your PHP ID card to healthcare providers each time you receive health services, never let another person use it, report its loss or theft to PHP, and destroy any old cards.
5. Be considerate and courteous to PHP associates, your providers, their staff, and other patients.
6. Notify PHP of any changes in address, eligible family members, marital status, or if you acquire other health care coverage.
7. Provide complete and accurate information (to the extent possible) that PHP and healthcare providers need in order to provide care.
8. Understand your health problems and develop treatment goals you agree on with your healthcare provider.
9. Follow the plans and instructions for care that you agree on with your healthcare provider.
10. Understand what services have cost shares to you and to pay them directly to the health care provider who gives you care.
11. Read your PHP member materials and become familiar with your provider network.
12. Follow your health plan benefits and PHP policies and procedures.
13. Report suspected health care fraud or wrongdoing to PHP by contacting PHP Customer Service.