Security Health Plan Members’ Rights and ResponsibilitiesSecurity Health Plan fosters an environment of mutual respect and cooperation between members, providers and health plan staff. Security Health Plan clearly communicates member rights and responsibilities to lay a solid foundation for the development of effective relationships between members, plan providers and staff.
Security Health Plan members have certain rights and responsibilities as members of the health plan. These rights and responsibilities demonstrate Security Health Plan’s commitment to treating members in a manner that respects their relationship with their provider and with Security Health Plan.
As a Security Health Plan member, you have the right to:
- Receive information about the organization including its programs and services, its providers and staff qualifications and contractual relationships, its facilities, and member rights and responsibilities.
- Decline participation or disenroll from programs and services offered by Security Health Plan.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
- Be treated with fairness, dignity and respect regardless of your race or color, age, gender identity, sexual orientation, marital status, arrest or conviction record, military participation, religion, national origin, cultural or educational background, economic or health status, or any mental or physical disability.
- If you think you have been treated unfairly or your rights have not been respected due to any of the above, you should call the Department of Human Services’ Office for Civil Rights or call your local Office for Civil Rights.
- Be free to exercise your rights, and that the exercise of those rights does not adversely affect the way Security Health Plan and its network providers treat you.
- Be furnished health care services, including:
- Timely access to care and services;
- Delivery of services in a culturally competent manner, including behaviors by providers and subcontractors that effectively address interpersonal communication styles which respect cultural backgrounds (see reference documents on Security Health Plan’s online Compliance Toolkit); and
- Accessibility to network providers that provide physical access, reasonable accommodations, and accessible equipment to you, if you have physical or mental disabilities
- Have your treatment remain confidential.
- You have the right to confidential treatment of all communication and records pertaining to your care.
- Except as authorized by law, we must get written permission from you or your authorized representative before medical records can be made available to any person not directly concerned with your care or responsible for making payments for the cost of such care.
- You have a right to request to inspect and/or obtain a copy of Protected Health Information (PHI), which is maintained by Security Health Plan.
- You have the right to ask your physician to make additions or corrections to your PHI.
- You have a right to request to whom your health information had been given and for what purposes.
- See Plan providers and ensure you get covered services and drugs within a reasonable period of time.
- You have the right to choose a plan provider who is part of Security Health Plan's provider network.
- You have the right to timely access to your providers and to see specialists when care from a specialist is needed.
- Know your treatment choices and participate with providers in making decisions about your health care.
- Your providers must explain things in a way that you can understand.
- You have the right to ask for an interpreter and have one provided to you during any covered service.
- You have a right to know about all treatment choices that are recommended for your condition, including the right to request a second opinion, no matter what they cost or whether they are covered by Security Health Plan.
- You have a right to be told about the risks involved in your care.
- You must be told in advance if any proposed medical care is part of a research experiment and be given the right to refuse the experimental treatment.
- You have the right to refuse treatment (including leaving a hospital or other medical facility).
- Voice complaints or appeals (reconsiderations) about the organization or the care it provides without facing discrimination. You have a right to get a summary report of information about the appeals and grievances that have been filed against Security Health Plan.
- Communicate complaints to the organization and receive instructions on how to use the complaint process, including standards of timeliness for responding to and resolving issues of quality and complaints.
- Be informed about your health care coverage and costs in an appropriate language or format.
- You have a right to be told what medical services are covered for you as a plan member and what you have to pay.
- You have the right to an explanation from us about any bills you may get for non-covered services.
- Make recommendations regarding the organization's member rights and responsibilities policies.
- Make an advance directive about your health care choices and to have it placed in your medical record (e.g. living will or power of attorney for health care).
- Have any questions or concerns about your rights and protections answered by us.
As a Security Health Plan member, you have the responsibility to:
- Use affiliated providers for your care. (Other providers may be seen if necessary for emergency care or for urgent care when you are out of the area.) Affiliated providers are listed in your provider directory.
- Be honest with your providers and give them any information they need to take care of you.
- Follow the medical treatment plan you and your provider have agreed upon.
- Understand your health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
- Be familiar with your coverage and the rules you must follow to get care as a member.
- 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.
- Pay your premiums and any copayments, coinsurance and deductibles you may owe.
- Let us know if you have any questions, concerns, problems, or suggestions.
- Seek follow up care with an affiliated provider, even if you were originally seen by a non-affiliated provider for your urgent or emergency care needs.
Security Health Plan distributes the Members’ Rights and Responsibilities to new and existing members and providers as follows:
- This policy content is published annually and distributed to all members and providers via the Evidence of Coverage/Certificate/Policy.
- Information as to where to locate the Member Rights and Responsibilities document along with other important legal documents on our website is provided in the member handbooks and Annual Notice of Coverage letter document, if the full document is not provided to our members.
- This policy is made available for all members and providers via the Security Health Plan public website.
Security Health Plan staff electronically acknowledge this policy on an annual basis.