Commercial - Member Eligibility |
Member Rights and Responsibilities
ConnectiCare provides each member
with a statement of Member Rights and Responsibilities. Following is the
statement in its entirety.
RIGHTS
Members are encouraged to actively participate in decision-making
with regard to managing their health care. As a member of a ConnectiCare plan,
each individual enjoys certain rights and benefits. Members have the right
to:
• Receive information about us, our
services, our participating providers, and "Member’s Rights and
Responsibilities."
• Be treated with respect and recognition of your dignity and right
to privacy.
• Participate with practitioners in decision-making regarding your
health care.
• A candid discussion of appropriate or medically necessary
treatment options for your condition,
regardless of cost or benefit coverage.
• Refuse treatment and to receive information regarding the
consequences of such action.
• Voice complaints or appeals about us or the care you are
provided.
• Make recommendations regarding our member’s rights and
responsibilities policies.
• Refuse to authorize the transfer of records, understanding that
such action may terminate the physician/patient relationship, and result
in the denial of benefits and cause any associated Appeal Process to be
terminated, and may require you to disenroll from this Plan.
RESPONSIBILITIES
While enjoying specific rights of membership, each ConnectiCare
member also assumes the following responsibilities. Members have the
responsibility to:
• Select a Primary Care Physician (PCP).
• Provide, to the extent possible, information we and providers need
to render care.
• Follow the plans and instructions for care that they have agreed
on with practitioners.
• Keep scheduled appointments or give sufficient advance notice of
cancellation.
• Pay established copayments, deductibles or applicable
coinsurance.
• Follow the rules of this Plan, and assume financial responsibility
for not following the rules.
• Understand their health problems and participate in developing
mutually agreed upon treatment goals to the degree possible.
• Be considerate of our providers, and their staff and property, and
respect the rights of other patients.
• Read the Membership Agreement, Evidence of Coverage, or other
Plan document that describes the Plan’s benefits and rules
Members’ rights and our obligations are limited to our ability to make a good
faith effort in regard to:
• Delays and failures to render services due to a major disaster or
epidemic affecting our facilities or personnel.
• Circumstances beyond our control such as complete or partial
destruction of facilities, war, or riot.
