View your rights and responsibilities as a member of The Health Plan:
We want you to better understand your coverage at The Health Plan.
*For paper copies of any of the information below, contact our Customer Services Department.
Member rights and responsibilities
Why should you call us
- Ask questions about services, benefits, or claims
- Change your primary care provider (PCP) or get help choosing a provider
- File a complaint
- Replace a lost member ID card
- Get help with referrals
- Let us know if you are pregnant or have given birth
- Request interpreter services or help for people with disabilities
- Let us know if there have been changes to your name, address, or phone number
- Notify us of:
- Changes in any other health insurance coverage you have
- Any liability claims, such as claims from an automobile accident
- Admission to a nursing home
- Care received in an out-of-area or out-of-network hospital or emergency room
- A caregiver or other representative to speak on your behalf
How to obtain language assistance
If you speak English, language assistance services, free of charge, are available to you. Call 1.877.847.7915 (TTY: 711). Medicaid members please call 1.888.613.8685.
Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1.877.847.7915 (TTY: 711). Miembros de Medicaid por favor llame al 1.888.613.8685.
We can provide documents in other languages, and other formats, including large print, at no cost to you. Call us toll-free at 1.800.624.6961 (TTY: 711).
What is an HRA
A health risk assessment (HRA) is a tool that helps guide you towards better health. The HRA can be taken from the comfort of your own home.
Topics covered include healthy body weight, tobacco use, physical activity, healthy eating, managing stress, avoiding at-risk drinking, and identifying depression. Log in at myplan.healthplan.org to get started. Your results will be immediately available to you and will be kept confidential.
We can also send you a paper copy or help you to take the assessment over the phone.
How to select a primary care provider (PCP)
A primary care provider (PCP) takes care of your routine health care needs. Each member of The Health Plan chooses a PCP from the provider directory. Customer Service can help you select a provider to fit your needs. If you do not pick a PCP for yourself, we may choose one for you. If you have a chronic illness, you may be able to select a specialist as your PCP. Your PCP’s name and address may appear on your member ID card depending on your benefit plan.
You can change your PCP for any reason. Let us know right away by calling Customer Service. If your PCP leaves our network, we will let you know by mail within 14 calendar days. We can assign you a new PCP, or you can pick a new one yourself within 30 days of the notice.
Members with a PPO plan are not required to select a PCP and can see the health care provider of their choice, although more of the costs will be covered if you choose one of our contracted providers.
How to obtain information about practitioners who participate in our network
In-network doctors, specialists, or hospitals are listed in our provider directory. For plan-specific results, search by line of business. You can search providers by:
- Hospital affiliation
- Languages spoken
- Office location
The directory will also tell you if the provider is accepting new patients. Compare hospitals to see their location and phone number, accreditation status, and quality data.
Inquiries regarding a practitioner’s medical school attendance or residency completion may be answered by Customer Service or visit these websites:
How to obtain specialty care and hospital services
Refer to our Find a Doc webpage to find in-network specialists and other providers. Please call Customer Service at 1.800.624.6961 for more information.
What if you have an emergency?
The nurse on call is available 24 hours a day, 7 days a week at 1.800.624.6961.
Emergency services (including emergency room) are provided by a hospital emergency facility and includes emergency transportation. Emergency services are provided 24 hours a day, 7 days a week whether you are in or out of the service area to evaluate, treat, and stabilize a medical condition and includes, when appropriate, provisions for transportation and indemnity payments or service agreements for out-of-area coverage. True emergency services are covered without regard to prior authorization whether you are in or out of the service area.
- How to have your medication reviewed
- How to view a list of approved medications
- How to request medication not on the formulary
- How to voice a complaint, or file an appeal or grievance
- How are we doing?
- Privacy practices, use and disclosure
- Understanding advance directives
- How to report healthcare fraud