Statement of your Member Rights and Responsibilities

It is important to know your Rights and Responsibilities when it comes to your health care. This section describes your rights and responsibilities as a Chartered Health Plan Member.  Understanding this section is an essential part of your role to help us provide the best health care possible to you and your family.

YOUR RIGHTS AND RESPONSIBILITIES

YOUR RIGHTS AS A MEMBER

As a member of Chartered Health Plan, you have the right to:

• Be treated with dignity and respect.
• Receive all covered services listed in the handbook.
• Be given good, quality care.
• Have a way to get health care services 24 hours a day, 365 days a year.
• Choose a PCP from Chartered’s list of providers.
• Change a PCP and choose another one from Chartered’s list of providers.
• Receive health care in the comfort and convenience of a provider’s office.
• To be sure that others cannot hear or see you when your are getting medical care
• Make your  own doctor appointments.
• Be a part of health education programs offered by Chartered.
• Have your  medical records remain private, according to HIPAA rules.
• Have access to your  medical records in accordance with applicable federal and state laws.
• Get quick and polite responses to questions and concerns.
• Be told of any changes that have something to do with your  health services or how to get them.
• Receive information about Chartered, our services, our providers and other health care workers, our facilities, and your rights and responsibilities as a member.
• Make recommendations about the members’ rights and responsibilities.
• Have a discussion about the health care you need, regardless of cost and regardless if Chartered covers it. 
• Have access to case management services.
• Request information regarding advance directives and receive assistance in preparing them.
• Participate in making  medical decisions, including the right to refuse treatment.
• To be told if a health care provider is a student and to be able to refuse his/her care
• Receive authorization policies and procedures.
• Be aware of incentive plans for Chartered’s providers.
• Receive a summary of the most recent patient satisfaction survey.
• Receive a copy of Chartered’s prescription drug formulary.
• Receive information on alternative medically necessary treatment options and alternatives, presented in a manner appropriate to your  condition and easy to understand.
• (Female enrollees only) Have direct access to a women’s health specialist within the network for covered care necessary to provide women’s routine and preventive health care services.  Also, female enrollees have a right to designate as their PCP a participating provider or an advanced-practicing registered nurse who specializes in obstetrics (OB) and gynecology (GYN).
• Seek a second opinion from a qualified health care professional within the network or out-of-network at no cost.
• Choose an appropriate participating specialist as your  PCP if you  have a chronic, disabling, or life threatening medical condition.
• Receive free interpreter services as needed, including help with sign language, if hearing impaired
• File a complaint or appeal orally or in writing .
• Have someone assist you with getting information regarding the qualifications and titles of those responsible for your  care.
• Refuse the care of your  provider.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in Federal regulations on the use of restraints and seclusion.
• Be given upon request the current clinical practice guidelines

YOUR RESPONSIBILITIES AS A MEMBER

Chartered and your provider can serve you better if you:

• Treat Chartered employees and providers with respect.
• Choose a primary care provider (PCP) from Chartered’s list of providers.
• Get medical care through Chartered’s list of participating providers, hospitals and clinics.
• Get approval from your  PCP or Chartered before being seen by another provider.
• Carry your Chartered membership card with you at all times.
• Give Chartered and your  PCP accurate information needed to give you care.
• Let Chartered know of any changes, such as:
  • Change of address or telephone number
  • Change of name
  • Death of a family member
  • New additions to the family, such as a baby
  • Other insurance coverage
  • A move to somewhere outside of the District of Columbia
• Inform Chartered of how we can work better for you.
• Keep your  doctor’s appointments or call to cancel at least 24 hours in advance.
• Whenever you  visit the doctor’s office, tell the doctor you  are a Chartered member.
• Ask questions, talk with your  provider about your  health and listen to what treatment is needed. 
• Understand your  health problems and follow the provider’s instructions for care after you  both have decided what treatment is needed. 
• Know the difference between a true emergency and a condition needing urgent care.
• Know what an emergency is; how to keep emergencies from happening; and what to do if one does happen.
• Report to Chartered at the time of enrollment if you are in the course of care or treatment.