Member Rights and Responsibilities

Here’s what you should know

You have the right to understand your specific eternalHealth plan, including your benefits, coverage, and providers; and to:

• Receive information in a language that is easiest for you to understand (Spanish, French, etc.).
• Obtain an Evidence of Coverage form, which contains all the details of your plan.
• Receive information about our network providers and how to utilize their services, including our network pharmacies.
• Receive information about your coverage and the rules you must follow when using your coverage.
• Receive information about why a service or drug is not covered, and what you can do about it.

You have the right to be treated with respect and decency while accessing high-quality care, which allows you to:

• Receive our services and care regardless of your race, ethnicity, national origin, age, disability, sex, sexual orientation, gender identity, or financial status.
• See providers who can meet your physical needs and follow the guidelines of the Americans with Disabilities Act.
• Utilize your rights without any concern of possible discrimination, penalization, or unfair treatment for doing so.
• Receive quality care and services in a comfortable setting and in an adequate amount of time.
• Be proactive in your healthcare decisions, including the right to refuse or agree to medical care and select and alter your medical provider.
• Visit a Primary Care Provider (PCP) who guides you through every step of your care.

You have the right to make end-of-life care decisions, which allows you to:

• Construct and alter your living will or durable power of attorney for healthcare.
• Have your end-of-life wishes respected, if permitted by state and federal laws.
• Be proactive in decisions regarding life sustaining treatments, including end-of-life care.

You have the right to request appeals and file complaints (which you may see referred to as the formal “grievance”), which allows you to:

• Appeal (contest) a decision we make and get a response within the time frame required by law.
• Speak up regarding opinions, concerns, comments, or complaints about your care, treatment, or any other services. In doing so, you have the right to not be treated any differently.
• Get a response to your complaints within an adequate amount of time, no more than 30 days.
• Find out more information about your ability to file an appeal or grievance below.

You have the right to privacy and confidentiality, which allows you to:

• View and ask questions about our Privacy Policy, which explains how we handle your Personally Identifiable Information (Name, Address, etc.).
• View and ask questions about our Notice of Privacy Practices, which explains how we handle your Protected Health Information (information related to your health, healthcare such as medical conditions or billing).
• Tell us who you would like to share your protected health information with. You can find that form here.
• You have the right to contact eternalHealth for any issue relating to your eternalHealth coverage. For more information about prior authorizations for medical care, filing an appeal, or submitting a grievance you can click here.