Member Rights and Responsibilites
Member Rights and Responsibilites
All Jade Health Care Medical Group Members have the right to:
- Courteous and considerate treatment; to be treated with respect and recognition of their dignity and right to privacy.
- Receive information about Jade Health Care Medical Group, its services, its affiliated practitioners / providers, and members’ rights and responsibilities.
- Make recommendations regarding Jade Health Care Medical Group’s member rights and responsibilities policy.
- Be informed about their available health plan benefits, including a clear explanation about how to obtain services.
- Receive appropriate preventive health services as indicated in the member's Evidence of Coverage (EOC).
- Receive upon request, names, specialties and titles of the professionals responsible for their care.
- Amend their own health care information that Jade Health Care Medical Group has when they consider it is incorrect or incomplete.
- Participate with Jade Health Care Medical Group affiliated practitioners in the decision making regarding their health care.
- Inspect and copy their own medical information used to make decisions about their health care.
- Request a confidential or candid discussion with Jade Health Care Medical Group's contracted qualified Medical Management staff regarding ones health matter and appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Receive reasonable information regarding the risk for a given treatment, the length of disability and the qualifications of the care provider prior to giving consent for any procedure.
- Additional medical or surgical opinions from out-of–network providers, in situations when your treating physician or the Plan feels this would be helpful in determining a diagnosis or course of treatment (with an approved referral).
- Be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.
- Be fully informed of ’s grievance procedure and how to use it without fear of prejudicial treatment from their health care provider.
- Voice complaints or appeals about Jade Health Care Medical Group or the care provided.
- A timely response to request for services, complaints and inquiries regarding their health benefits and services.
- Request a copy of Jade Health Care Medical Group’s Notice of Privacy Practices.
Members are responsible:
- For knowing and understanding their health benefits and services and how to obtain them.
- For contacting their physician or Health Plan or Medical Group coordinator with any questions or concerns regarding health benefits or services.
- To provide, to the extent possible, information that Jade Health Care Medical Group and its affiliated practitioners / providers need in order to care for them.
- To understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- For cooperating with those providing health care services; however, they have the right to refuse medical treatment.
- To follow the plans and instructions for care that they have agreed upon with their practitioners.
- To provide Jade Health Care Medical Group with information when another source is responsible to pay for health care is involved, such as liability insurance after an accident. In these cases, members have the responsibility to cooperate with their affiliated health plan for proper reimbursement of injury treatment by the other source to their health plan.