Rights and Responsibilities

 

Alignment Health Plan HMO Members have the right:

To be treated with fairness, respect, dignity, and consideration for privacy; including protection from release of any information that identifies them to anyone other than those having an “identified need for the information”.

To the privacy of their medical records and personal health information. To have health and medical records, as well as any other information, treated with confidentiality, regardless of the format of that information (i.e., spoken communications, written materials, electronic records, or facsimiles).

To have access to their medical records in accordance with law.

To be free from discrimination based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

To see plan providers and get covered services within a reasonable period of time. To have services accessible and available to them.

To access emergency health care services without prior authorization.

To choose providers for both primary and specialty care, from among those affiliated with Alignment Health Plan HMO and/or the Medical Group and to refuse care from any specific providers.

To know treatment choices and participate in decisions about their health care.

To use an advance directive (such as a living will or a power of attorney).

To choose a representative to facilitate care or treatment decisions, including withholding resuscitative services or to forego or withdraw life-sustaining treatment, when they are unable to do so.

To receive information on available treatment options (including the option of no treatment) or alternative courses of care in a language they understand.

To make complaints and obtain a prompt resolution of issues (including complaints, grievances or appeals) relating to authorization, coverage, or payment of services.

To get information about their health care coverage and costs.

To get information about Alignment Health Plan HMO, their Medical Group and any contracted providers.

To get more information about their rights.


Alignment Health Plan HMO Members have the responsibility:

To become familiar with their coverage and the rules that must be followed to get care as a member.

To give doctors and other health care providers the information they need to provide health care.

To pay any applicable copayment, deductible, co-insurance or charge for non-covered services when requested by their Alignment Health Plan HMO/Medical Group physician.

To act in a way that supports the care given to other patients and helps the smooth running of the doctor’s office, hospital, and other offices.

To let us know if they have any questions, concerns or suggestions.


Disenrollment from Alignment Health Plan

Ending your membership in Alignment Health Plan may be voluntary (your own choice) or involuntary (not your own choice):

  • You might leave our plan because you have decided that you want to leave. There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. Please review Chapter 10 of your Evidence of Coverage (EOC) to view disenrollment periods and situations.

    The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing.
  • There are also limited situations where you do not choose to leave, but we are required to end your membership.

If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.

For more information on ending your membership, please refer to your Evidence of Coverage (EOC) Document, Chapter 10 or click on this link to view an EOC online: Evidence of Coverage (EOC)