Member Rights and Responsibilities

We want you to understand your rights and responsibilities as a member of Jai Medical Systems.

Please review your member rights and responsibilities, which are detailed below.

Member Rights

As a HealthChoice member, you have the right to:

• Receive health care and services that are culturally competent and free from discrimination.
• Be treated with respect to your dignity and privacy.
• Receive information, including information on treatment options and alternatives, regardless
  of cost or benefit coverage, in a manner you can understand.
• Participate in decisions regarding your health care, including the right to refuse treatment.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline,
  convenience, or retaliation.
• Request and receive a copy of your medical records and request that they be amended or
  corrected as allowed.
• Request copies of all documents, records, and other information free of charge that were used
  in an adverse benefit determination.
• Exercise your rights, and know that the exercise of those rights will not adversely affect the way
  that the Managed Care Organizations (MCOs), their providers, or the Maryland Department of
  Health treat you.
• Receive information about your rights and responsibilities and make recommendations about
  your rights and responsibilities.
• File appeals and grievances with your Managed Care Organization.
• File appeals and grievances with the State and your right to a State fair hearing.
• Request that ongoing benefits be continued during an appeal or State fair hearing however,
  you may have to pay for the continued benefits if the decision is upheld in the appeal or
  hearing.
• Receive a second opinion from another doctor within the same MCO, or by an out of network
  provider if the provider is not available within the MCO, if you do not agree with your
  doctor’s opinion about the services that you need. Contact your MCO for help with this.
• Receive information about the services provided by your Managed Care Organization
  including information about practitioners and providers within its network.
• Receive other information about how your Managed Care Organization is managed including
  the structure and operation of the MCO as well as physician incentive plans. You may request
  this information by calling your Managed Care Organization.

Member Responsibilities

As a HealthChoice member, you have the responsibility to:

• Inform your provider and MCO if you have any other health insurance coverage.
• Treat HealthChoice staff, MCO staff, and health care providers and staff, with respect and dignity.
• Be on time for appointments and notify providers as soon as possible if you need to cancel an appointment.
• Show your membership card when you check in for every appointment. Never allow anyone else to use your Medicaid or MCO card. Report lost or stolen member ID cards to the MCO.
• Call your MCO if you have a problem or a complaint.
• Work with your Primary Care Provider (PCP) to create and follow a plan of care that you and your PCP agree on.
• Ask questions about your care and let your provider know if there is something you do not understand.
• To understand your health problems and to work with your provider to create mutually agreed upon treatment goals that you will follow.
• Update the State if there has been a change in your status.
• Provide the MCO and their providers with accurate health information in order to provide
  proper care.
• Use the emergency department for emergencies only.
• Tell your PCP as soon as possible after you receive emergency care.
• Inform your caregivers about any changes to your Advance Directives.