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.