Medicare members have the right:
- To be treated with respect and understand their need for privacy and dignity.
- To get help in a prompt, courteous, responsible and culturally competent manner.
- To be given information about their health care benefits.
- To be given information about any limitations and services not covered by the plan.
- To be told by their Provider all of their medical information in words they understand.
- To talk with their Provider about their care.
- To expect the health plan not to interfere with any contracted Providers talking with them about their treatment choices.
- To have the health plan send them to another contracted Provider if he/she does not agree to a treatment because of moral or religious grounds.
- To be given information about the list of contracted Providers in their service area.
- To be told by their Provider about any treatment they may get.
- To have their Provider ask for their permission for all treatment, unless there is an emergency and they cannot sign a consent form and their health is in serious danger.
- To refuse treatment, including any trial treatment, and be told of the possible outcome of their choice.
- To choose an advance directive to pick the kind of care they wish to get if they become unable to express their wishes.
- To select, without interference, a primary care Provider of their choice from the health plan’s list of contracted Providers.
- To make suggestions about the member rights and responsibilities policy.
- To file a complaint about the health plan.
- To file a complaint about the care they have received and to get a timely response.
- To file a grievance if they are not satisfied with their health plan’s decision about their complaint.
- To get “timely access” to the records and information that pertains to them.
Medicare members have the responsibility:
- To know and confirm your benefits before getting treatment.
- To show your member ID card before getting services.
- To protect your member ID card from being used by another person.
- To verify that the Provider you get services from is part of the health plan network.
- To keep scheduled appointments.
- To pay any copayments/coinsurance at the time you get treatment.
- To ask questions and understand the care you are getting.
- To follow the advice of your Provider and be aware of the possible outcome if you do not.
- To tell us your opinions, concerns and complaints.
- To give information when asked to the health plan and contracted Providers that would help improve your health status.
- To use emergency room services only for an injury or illness that you might think may be a serious threat to your life or health.
- To follow the treatment plan agreed upon by you and your Provider.
- To give all the health plan staff respect and courtesy.
- To tell us of any change in address.
If you have questions or concerns about your rights, please call Centers Plan For Healthy Living Customer Care Group Service at at 1-877-940-9330; TTY users please call 1-800-421-1220, from 8:00 AM to 8:00 PM seven day a week. If you need help with communication, such as help from a language interpreter, customer service can assist you.
The Medicare program has written a booklet called Your Medicare Rights and Protection. To get a free copy, call 1-800-MEDICARE (1-800-633-4227) or TTY (1-877-486-2048) 24 hours a day, 7 days a week. Or you can access the Medicare website, to order the booklet or print it from your computer.
Appeals and grievances
As a plan member, you may request the number of grievances, appeals and exceptions filed with the plan, by contacting our Grievances and Appeals Department as follows:
Hours of Operation:
seven days a week, 8 a.m.-8 p.m.
Centers Plan for Healthy Living
Rights and Responsibilities upon Disenrollment
When can you end your membership in our plan?
- Each year from October 15 through December 7, you can make any type of change, including adding or dropping Medicare Prescription Drug Coverage also known as Part D
- Each year from January 1 through March 31, anyone enrolled in a Medicare Advantage Plan, like our plan, has an opportunity to disenroll from that plan and return to Original Medicare.
- As a rule of thumb, generally, you may not make changes at other times unless you meet certain special exceptions, such as the ones below:
- If you move out of the plan’s service area.
- If you have both Medicare and Medicaid, Extra Help for our prescription drug costs, or are enrolled in the Medicare Savings Program.
- If you move in or out of a Nursing Home.
- If our plan is no longer offered in your residential area.
Below are some of the way you use to end your membership in our plan:
- Written Request: By completing a Disenrollment Request form. This form must be signed by you (or your legal representative).
- Enrolling into another Medicare Advantage (MA) or Prescription Drug Plan (PDP): If you are planning to enroll, or have enrolled, in another Medicare Advantage or other Medicare Health Plan, enrolling in another Medicare plan will automatically disenroll you from our plan.
- By Telephone: You can call 1-800-MEDICARE (1-800-633-4227) anytime, 24 hours a day, 7 days a week to disenroll by telephone. TTY users should call 1-877-486-2048. If you’re receiving coverage through your employer, you should contact your employer instead of calling 1-800-MEDICARE to find out how this affects your retiree benefits.
Once Centers Plan for Healthy Living have received your request to disenroll , we will send you confirmation of your request within 10 calendar days of receiving your disenrollment request. Your disenrollment will become effective the first of the month following receipt of your request to disenroll.
Please note that Centers Plan for Healthy Living may deny your request to disenroll if:
- The request was made outside of an allowable period and you do not qualify for a Special Election.
- The request was made by someone other than yourself or your legal representative.
- The request was incomplete and the required information is not provided within the required time frame
We must protect the privacy of your personal health information.
Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.
You have the right to make complaints and to ask us to reconsider determinations we have made
What you need to do to follow up on a problem or concern depends on the situation. You might need to ask our plan to make a coverage determination for you, make an appeal to us to change a coverage determination or make a complaint. Whatever you do — ask for a coverage determination, make an appeal, or make a complaint — we are required to treat you fairly. You have the right to get a summary of information about the appeals and complaints that other members have filed against our plan in the past. To get this information, please call Member Services.