Member rights and responsibilities

Our members have rights and responsibilities. Our Member Services representatives serve as their advocates. Below are the rights and responsibilities of members.

Member rights

Members have the right to:

• Be cared for with respect, without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation or gender identity
• Be told where, when and how to get the services they need from Healthy Blue
• Be told by their PCP what health issues they may have, what can be done for them and what will likely be the result, in language they understand
• Get a second opinion about their care
• Give their approval of any treatment
• Give their approval of any plan for their care after that plan has been fully explained to them
• Refuse care and be told what they may risk if they do
• Get a copy of their medical record and talk about it with their PCP 
• Ask, if needed, that their medical record be amended or corrected
• Be sure that their medical record is private and will not be shared with anyone except as required by law, contract or with their approval
• Use the Healthy Blue complaint process to settle complaints.
• Use the State Fair Hearing system
• Appoint someone they trust (relative, friend or lawyer) to speak for them if they are unable to speak for themselves about their care and treatment
• Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints

Member responsibilities

As a member of Healthy Blue, members agree to:

• Work with their PCP to protect and improve their health
• Find out how their health plan coverage works
• Listen to their PCP’s advice and ask questions
• Call or go back to their PCP if they do not get better or ask for a second opinion
• Treat health care staff with the respect
• Tell us if they have problems with any health care staff by calling Member Services at 1-844-594-5070
• Keep their appointments. If they must cancel, call as soon as they can.
• Use the Emergency Department only for emergencies
• Call their PCP when they need medical care, even if it is after hours