Rights and Responsibilities
Since you have Medicare, you have certain rights to help protect you. You have the
right to be treated with dignity, respect, and fairness at all times. Central Health
Medicare Plan must obey laws against discrimination that protect you from unfair
treatment. These laws say that we cannot discriminate against you (treat you unfairly)
because of your race or color, age, religion, national origin, or any mental or
physical disability you may have.
Your right to the privacy of your medical records and personal health information
There are federal and state laws that protect the privacy of your medical records
and personal health information. We keep your personal health information private
as protected under these laws. Any personal information that you give us when you
enroll in this plan is protected. We will make sure that unauthorized people do
not see or change your records. Generally, we must get written permission from you
(or from someone you have given legal power to make decisions for you) before we
can give your health information to anyone who is not providing your care or paying
for your care.
Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time
You will get most or all of your care from plan providers, that is, from doctors
and other health providers who are part of Central Health Medicare Plan. You have
the right to choose a plan provider (we will tell you which doctors are accepting
new patients). You have the right to go to a women’s health specialist (such as
a gynecologist) without a referral. You have the right to timely access to your
providers and to see specialists when care from a specialist is needed. You also
have the right to timely access to your prescriptions at any network pharmacy.
Your right to know your treatment choices and participate in decisions about your health care
You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. Your providers must explain things in a way that you can understand. Your rights include knowing about all of the treatment choices that are recommended for your condition, no matter what they cost or whether they are covered by Central Health Medicare Plan. This includes the right to know about the different Medication Management Treatment Programs we offer and which you may participate. You have the right to be told about any risks involved in your care. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments.
You have the right to receive a detailed explanation from us if you believe that a plan provider has denied care that you believe you are entitled to receive or care you believe you should continue to receive. You have the right to refuse treatment. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. This includes the right to stop taking your medication. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.
Your right to use advance directives (such as a living will or a power of attorney)
You have the right to ask someone such as a family member or friend to help you
with decisions about your health care. Sometimes, people become unable to make health
care decisions for themselves due to accidents or serious illness. If you want to,
you can use a special form to give someone you trust the legal authority to make
decisions for you if you ever become unable to make decisions for yourself. You
also have the right to give your doctors written instructions about how you want
them to handle your medical care if you become unable to make decisions for yourself.
The legal documents that you can use to give your directions in advance in these
situations are called "advance directives." There are different
types of advance directives and different names for them. Documents called "living
will" and "power of attorney for health care" are
examples of advance directives.
Your right to make complaints
You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "grievances" are the two different types of complaints you can make. Which one you make depends on your situation.
If you make a complaint, we must treat you fairly (i.e., not discriminate against
you) because you made a complaint. You have the right to get a summary of information
about the appeals and grievances that members have filed against Central
Health Medicare Plan in the past.
Your right to get information about your health care coverage and costs
You have the right to an explanation from us about any bills you may get for services
not covered by Central Health Medicare Plan. We must tell you in writing
why we will not pay for or allow you to get a service, and how you can file an appeal
to ask us to change this decision.
Your right to get information about Central Health Plan of California, Inc., Central Health Medicare Plan, plan providers, your drug coverage, and costs
You have the right to get information from us about Central Health Plan of California,
Inc. and Central Health Medicare Plan. This includes information about our financial
condition, about our health care providers and their qualifications, and about how
Central Health Medicare Plan compares to other health plans. You have the right
to find out from us how we pay our doctors. You have the right to get information
from us about Central Health Plan of California, Inc. and Part D. This includes
information about our financial condition and about our network pharmacies.
What are your responsibilities as a member of Central Health Medicare Plan?
Along with the rights you have as a member of Central Health Medicare Plan, you also have some responsibilities. Your responsibilities include the following:
To get familiar with your coverage and the rules you must follow to get care as a member. You can use the Evidence of Coverage and other information we give you to learn about your coverage, what you have to pay, and the rules you need to follow.
To give your doctor and other providers the information they need to care for you, and to follow the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your doctors and other providers if you have any questions.
To act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals, and other offices.
To pay your plan premiums and any co-payments you may owe for the covered services you get. You must also meet your other financial responsibilities.
To let us know if you have any questions, concerns, problems, or suggestions.