Rights and Responsibilities

As a Harbor Health Choice Member, there are certain rights and responsibilities that go along with the care you receive. Click on the menus below to review your rights — what you are empowered to do as a Member — and your responsibilities — what you must do in order to receive the highest quality of care.

If you have any questions about your health plan rights and responsibilities, don't hesitate to call Member Services at (866) 420-6782, TTY 711, 8 a.m.-8 p.m. Monday-Friday with the exception of major holidays.

Your Responsibilities

• Reading the Policy/EOC/COI/COC (as applicable), Schedule of Benefits and Member materials.

• Understanding and complying with the terms and conditions of your health benefits.

• Paying your Premiums in a timely manner.

• Calling us if you have questions.               

• Coordinating medical services through your PCP or other Participating Physician, except in case of an Emergency Care situation.

• Obtaining Pre-Authorization from us as specified in in your Policy/EOC/COI/COC (as applicable), except in an Emergency Care situation.

• Complying with the limits of any Services.

• Using Participating Providers for all Services and supplies (except for Emergency Care or Pre-Authorized by us).

• Contacting Healthcare Providers to arrange appointments.

• Telling Healthcare Providers in a timely manner if you need to cancel an appointment.

• Paying any required cost shares at the time service is provided.

• Presenting your ID card before you get a service.

• Collaborating with Healthcare Providers to make informed decisions about the care you get and to understand your risks.

• Following instructions and working towards treatment goals that you and your Healthcare Provider agree upon. You may participate in developing your treatment goals when possible. We or your Healthcare Providers may ask you to enter into an explicit written agreement setting forth your treatment plan to ensure you understand it.

• Supplying us and your Healthcare Providers with accurate and complete information to ensure you get proper care.

• Telling Healthcare Providers and us if you have other health plan coverage.

• Providing accurate information on your Enrollment Form and in any other information you provide to us.

• Promptly telling us of any change in address.

• Promptly telling us if your ID Card is stolen.

• Cooperating with us to prevent unauthorized use of your ID Card and anyone from obtaining benefits in your place.

• Promptly telling us if you get information or materials by mistake and cooperating with us to return the information or material in a timely manner.

• Treating Healthcare Providers and their staff with respect.

Your Rights

• Get prompt medical care appropriate for your condition. This includes emergency care.

• Discuss all treatment options available to you regardless of coverage limits.

• Get information about us, our services and our Healthcare Providers.

• Collaborate with Physicians and Healthcare Providers to make informed care decisions.

• Be treated with respect.

• Have your privacy protected.

• Have your medical and financial records maintained by us kept confidential. We will not disclose your medical information without Your consent, except as allowed by law and our privacy practices.

• Be notified in a timely manner if we release information about you in response to a court order.

• Inspect your medical records and those of your minor dependents. Your right as a parent or legal guardian to access medical records without his or her consent may be limited by state or federal law.

• Let us know about the quality of care you get from a Participating Provider.

• File or register a complaint or file an appeal with us or the appropriate State Department of Insurance.

• Initiate a legal proceeding if you experience a problem with us or Providers after You complete our complaint and appeals process.

• File or register a complaint or file an appeal or initiate legal proceedings without retaliation by us.