Member rights and responsibilities

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Member rights and responsibilities

Commercial HMO

As a member of Health First Health Plans, you have certain rights and responsibilities.

As a member, you have the right:

To receive information about Health First Health Plans, its services, its practitioners and providers, and members' rights and responsibilities;
To have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage;
To voice complaints or appeals about Health First Health Plans or the care provided;
To know the name of the primary care physician coordinating your care and to request a change, in writing, of your primary care physician;
To receive information about our quality improvement programs, including progress being made.
To reasonable response to your requests and needs for treatment or services within the scope of Health First Health Plans' capacity, mission, and applicable laws and regulations;
To be informed about consent to treatment or refuse recommended treatment;
To participate in decisions involving your health care, including ethical issues and cultural and spiritual beliefs, unless concern for your health contraindicates;
To be treated with dignity and consideration as an individual with personal values and beliefs, given reasonable protection from harm, and afforded appropriate privacy;
To be informed about your diagnosis, testing, treatments, and prognoses. When concern for your health makes it inadvisable to give such information to you, such information will be made available to an individual designated by you or to a legally authorized individual;
To refuse treatment to the extent permitted by law and be informed of the consequences of your refusal. When refusal of treatment by the member or his/her legally authorized representative prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the member may be terminated upon reasonable notice;
To be assured of confidential treatment of disclosures and records, and afforded an opportunity to approve or refuse the release of such information, except when release is required by law;
To receive quality health care with respect and compassion regardless of race, age, sex, religious beliefs, source of payment, health status, or need for health services;
To determine the course of your treatment by issuing "advance directives." In accordance with the federal law titled "Patient Self-Determination Act" and the Florida Statute Chapter 765 titled "Health Care Advance Directives," you can make future healthcare decisions now with these types of advance directives:
- The "living will" states which medical treatments you would accept or refuse if you became permanently unconscious or terminally ill and unable to communicate.
- The "durable power of attorney for health care" or "designation of a healthcare surrogate" allow you to appoint someone else to make decisions regarding your health care when you are temporarily or permanently unable to communicate.

Additionally, you have the responsibility:

To understand your Health First Health Plans' benefits and plan guidelines;
If you are enrolled in an HMO plan, to use the designated Health First Health Plans' network of primary care physicians, referred specialists, and medical facilities (except for emergency care);
To provide your primary care physician, to the best of your knowledge, accurate and complete information about any current medical complaints, past medical history and any other information relating to your health;
To follow your physician's recommended treatment plan;
To reiterate to your physician whether you comprehend the treatment plan and what is expected of you;
To follow the provider's rules and regulations affecting patient care and conduct;
To keep your appointments and arrive promptly;
To notify your physician if you're unable to keep a scheduled appointment in a timely fashion;
To pay appropriate copayments according to the Summary of Benefits listed in the Contract and Certificate of Coverage;
To notify Health First Health Plans of any changes in your address, telephone number, or membership status.