Member rights and responsibilities

Members have the right to:

Privacy

• Be treated with respect and with due consideration for their dignity and privacy
• Expect that we will treat their records, including medical and personal information and communications, confidentially
• Request and receive a copy of their medical records at no cost to the member and request that the records be amended or corrected
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation as specified in federal regulations

Take part in decisions regarding their health care

• Receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand.
• Engage in candid discussions of appropriate or medically necessary treatment options for their conditions regardless of cost or benefit coverage
• Receive the appropriate services that are not denied or reduced solely because of medical condition
• Refuse health care (to the extent of the law) and understand the consequences
• Decide ahead of time the care they want if they become sick, injured or seriously ill by making a living will
• Be able to make decisions about their children’s health care if members are younger than age 18 and married, pregnant or have children

Grievances, appeals and fair hearings

• Pursue resolution of grievances and appeals about the health plan or care provided
• Freely exercise filing a grievance or an appeal without adversely affecting the way they are treated
• Continue to receive benefits pending the outcome of an appeal or a fair hearing under certain circumstances, where allowed by law

Wellpoint information

• Receive the necessary information to be a Wellpoint member in a manner and format they can understand easily
• Receive a current member handbook and a provider directory
• Receive a copy of the member handbook and/or provider directory by request by calling Member Services at 1-833-731-2153
• Receive assistance from Wellpoint in understanding the requirements and benefits of the plan
• Receive notice of any significant changes in the benefit package at least 30 days before the intended effective date of the change
• Make recommendations about our rights and responsibilities policies
• Know how we pay our providers

Medical care

• Choose their PCPs from our network of providers
• Choose any Wellpoint network specialist after getting a referral from their PCPs, if appropriate
• Be referred to health care providers for ongoing treatment of chronic disabilities
• Have access to their PCPs or backups 24 hours a day, 365 days a year for urgent or emergency care
• Get care right away from any hospital when their symptoms meet the definition of an emergency medical condition
• Get poststabilization services following an emergency medical condition in certain circumstances
• Be free from discrimination and receive covered services without regard to race, color, creed, gender, religion, age, national origin ancestry, marital status, sexual preference, health status, income status, program membership, or physical or behavioral disability, except where medically indicated