Member Rights and Responsibilities

eternalHealth is committed to being a member-centric health plan. Our goal is to provide you with all the information you need to accomplish your healthcare goals. This list shows you what to expect from us and the rights you have as an eternalHealth member.

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You Have the Right

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.
Page Last Updated On: December 5, 2022
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Tom Cunniffe

Director of Operations 

Tom Cunniffe comes to eternalHealth with over 20 years of healthcare operations’ experience, having held leadership positions in Call Center, Enrollment, Credentialing, UAT and Reimbursement teams. Tom has worked with Medicaid, Commercial and Medicare lines of business and has consistently built teams who are metrics driven with proven successful outcomes. Making sure our business strives for an efficient, best-in-class customer experience is at the center of Tom’s philosophy.

Tom has a bachelor’s degree from Fordham University and a master’s in business administration from University of Massachusetts at Amherst.

Tom Lawless

Chief Financial Officer

Tom Lawless has spent the past 20+ years building, sustaining, and growing new healthcare-related programs that balance fiscal responsibility & prudence with creativity & innovation, focusing on models of care that are novel, person-centered, and improve the social welfare of those who are served. He is very excited to continue doing so in his role as the Chief Financial Officer of eternalHealth.

Tom comes to eternalHealth from a not-for-profit, member-centric, health insurance cooperative. He helped the company continuously strive toward its dual goals of thriving financially, while keeping members at the very epicenter of its mission and service model. While there, Tom also spearheaded the creation of a brand new private, charitable foundation, which will be meaningfully giving back to those in need in the surrounding communities for years to come. Previously, Tom worked in the finance department of a successful hospice that provided high-quality care to persons experiencing their unique and poignant end-of-life journeys, assuring that the appropriate financing was always available. Tom’s career began as a civil servant in the Wisconsin Medicaid program, where he helped to create a program that expanded the institutional entitlement to care into home and community-based settings. Starting with only a blueprint in hand, the program now serves more than 57,000 frail elders and disabled adults and is considered a national model. Growing into a senior leadership role, Tom was a key architect of an innovative financing model, through which the public and private sectors successfully collaborated to better the lives of persons in great need.

Tom holds undergraduate and graduate degrees from the University of Chicago, with additional graduate work in economics completed at the University Wisconsin-Madison.

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