MEMBER RIGHTS

1. Be given information about your rights and responsibilities as a member.
2. Be treated at all times with respect, consideration, dignity and privacy.
3. Get information about all medically necessary health services, including clear details of how to locate and use them.
4. Services as covered under the plan, provided that these services are from participating providers.
5. Know that your medical records and letters are treated in a private manner.  They will only be given as required by law or permitted by you.
6. You have the right to review your medical record with your primary care provider (PCP).
7. Choice of a PCP from a list of participating providers.
8. Full information on the nature and effect of any treatment, test or procedure that may be involved in your health care, regardless of cost or benefit coverage.
9. Take part in decisions involving your health care.
10. Make decisions to accept or refuse medical or surgical treatment.
11. Be given information on the effects of refusing or not following treatment.
12. Refuse to participate in new research.
13. The use of the plan's problem resolution process.
14. Choices on "Advance Directives."  Advance Directives is a term used to describe a lan for medical treatment.  It will state what you want if you are not able to tell providers in your words.  This choice is made before it happens.
15. Be told about the plan, its services and the health care providers and practitioners who give health care.
16. Voice complaints or appeals about the plan or the care given.
17. Make suggestions regarding PHP-FC's member rights and responsibilities policies.

1. You must select a primary care provider (PCP) from PHP FamilyCare’s list of providers.
2. All medical care, except in emergencies, or as otherwise stated in the Member handbook, must be from a plan provider. All visits to non-participating providers must be approved first by PHP FamilyCare.
3. All hospitalizations must be approved. Your doctor will make the plans and contact PHP FamilyCare. This does not apply to emergencies or for urgently needed health services.
4. Emergency Room (ER) services may be used only for treatment of serious medical conditions. These would result from injury, sickness or mental illness which arises suddenly and requires immediate care and treatment. ER treatment is needed generally within 24 hours of the problem.
5. You must make visits with your PCP as far in advance as possible. Call if you are unable to keep an appointment.
6. You must always carry your PHP FamilyCare ID card. Show your Medicaid mihealth card and other health plan cards each time you receive health services. Never let someone else use your cards.
7. Report any lost or stolen health cards. Call PHP FamilyCare Customer Service if your health plan ID card is missing.  Call the Beneficiary Helpline at 1-800-642-3195 if your mihealth card is missing.
8. Call our Customer Service Department if you have a question about your plan coverage.
9. You must notify the plan of any changes in your address, family size and marital status, or if you have other health insurance coverage.
10. You must provide complete information about your health and health care to the health plan and your doctor in order for them to care for you.
11. Work with your PCP to manage your health problems and treatment goals.
12. You must follow the steps for care that you agree on with your PCP.
13. You must pay all required copayments directly to the PCP who gives you care.