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Member Rights and Responsibilities

We value our relationship with you and believe that setting clear expectations about our partnership is a critical part of earning your trust. The following rights and responsibilities represent the cornerstone of our successful future, and we encourage you to become familiar with them.

As a member, you have the right:

To receive these rights and responsibilities, as well as other information about Health First Health Plans and its benefits, services and providers.

To be treated with respect and recognition of your dignity and right to privacy. (See our Notice of Privacy Practices section for additional information.)

To participate with practitioners in decisions involving your health care, considering ethical, cultural and spiritual beliefs, unless concern for your health indicates otherwise.

To have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage. You have the right to receive this information in terms you understand.

To receive a prompt response when you ask questions or request information.

To be informed of who is providing your medical care and who is responsible for your care.

To be informed if your health care provider plans to use experimental treatment for your care. You have the right to refuse to participate in such experimental treatment.

To receive a reasonable estimate of charges for your medical care and a copy of an itemized bill, reasonably clear and understandable and have the charges explained to you.

To receive information about copayments and fees that you are responsible to pay.

To know what patient support services are available to you, including whether an interpreter is available if you do not speak English.

To be informed about your diagnosis, testing, treatments, and prognoses. When concern for your health makes it inadvisable to give such information to you, such information will be made available to an individual designated by you or to a legally authorized individual.

To be informed about consent to treatment, your right to refuse treatment to the extent permitted by law, and the consequences of your refusal. When refusal prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the member may be terminated by the provider upon reasonable notice.

To receive quality, timely health care with respect and compassion regardless of race, age, sex, religious beliefs, source of payment, health status, or need for health services.

To receive treatment for any emergency medical condition that will get worse from failure to obtain the treatment.

To know in advance of obtaining treatment, if you are eligible for Medicare, whether the health care provider or health care facility accepts the Medicare assignment rate.

To determine the course of your treatment by issuing "advance directives." In accordance with the federal law titled "Patient Self-Determination Act"; and the Florida Statute Chapter 765 titled "Health Care Advance Directives," you can make future healthcare decisions now with these types of advance directives:

  • The "living will" states which medical treatments you would accept or refuse if you became permanently unconscious or terminally ill and unable to communicate.
  • The "durable power of attorney for health care" or "designation of a healthcare surrogate" allows you to appoint someone else to make decisions regarding your health care when you are temporarily or permanently unable to communicate.

To have your medical records kept private, except when you provide your consent or when permitted by law.

To choose a primary doctor to coordinate your care and to change your doctor at any time.

To receive information about our quality improvement programs, including the progress being made.

To make recommendations regarding our member rights and responsibilities policies.

To receive information and necessary counseling on the availability of known financial resources for your care.

To know what rules and regulations apply to your conduct.

To voice complaints or appeals about Health First Health Plans or the care provided.

Additionally, you have the responsibility:

To understand your Health First Health Plans benefits and plan guidelines.

To supply accurate and complete information, including unexpected changes in your health condition, (to the extent possible) that Health First Health Plans and your providers need in order to provide you care.

To provide your primary doctor, to the best of your knowledge, accurate and complete information about any current medical complaints, past medical history and any other information relating to your health.

To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.

To follow the plans and instructions for care that you have agreed on with your providers.

To be responsible for your actions if you refuse treatment or do not follow your healthcare provider’s instructions.

To follow the provider's rules and regulations affecting patient care and conduct, including keeping your appointments and arriving promptly, and notifying your physician if you're unable to keep a scheduled appointment in a timely fashion.

To pay your cost-share or any other applicable fees according to your Summary of Benefits.

To notify Health First Health Plans of any changes in your address, telephone number, or eligibility status.

If you are enrolled in an HMO Plan, to use the designated Health First Health Plans participating primary care physicians, specialists, and medical facilities — except for emergency care.