PPO II - EmblemHealth

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2013 Evidence of Coverage for PPO II Chapter 8: Your Rights and Responsibilities SECTION 1 OUR PLAN MUST HONOR YOUR RIGHTS AS A MEMBER OF THE PLAN Section 1.1 We must provide information in a way that works for you (in languages other than English, in Braille, in large print, or other alternate formats, etc.) To get information from us in a way that works for you, please call Customer Service (phone numbers are printed on the back cover of this booklet). Our plan has people and free language interpreter services available to answer questions from non- English speaking members. Information is available for free in other languages. We can also give you information in Braille, in large print, or other alternate formats if you need it. If you are eligible for Medicare because of a disability, we are required to give you information about the plan’s benefi ts that is accessible and appropriate for you. If you have any trouble getting information from our plan because of problems related to language or a disability, please call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week, and tell them that you want to fi le a complaint. TTY users call 1-877-486-2048. Sección 1.1 Nosotros debemos proporcionar información en una forma conveniente para usted (en idiomas aparte del inglés, en sistema Braille, en letras grandes u otros formatos alternativos, etc.) Para obtener información de nosotros en una forma conveniente para usted, por favor llame a Servicio al Cliente (los números de teléfono están impresos en la contraportada de este folleto). Nuestro plan tiene representantes y servicios de intérpretes de idiomas gratis para contestar preguntas de miembros que no hablan inglés. La información está disponible gratis en otros idiomas. También podemos darle información en sistema Braille, en letras grandes u otros formatos alternativos si usted lo necesita. Si usted es elegible para Medicare debido a una discapacidad, tenemos la obligación de darle información sobre los benefi cios del plan de una forma accesible y apropiada para usted. Si usted tiene cualquier difi cultad en obtener información de nuestro plan debido a problemas relacionados con el idioma o una discapacidad, puede llamar a Medicare al 1-800-MEDICARE (1-800-633-4227), las 24 horas del día, los 7 días de la semana y decirles que usted desea presentar una queja. Los usuarios de TTY deben llamar al 1-877-486-2048. Section 1.2 We must treat you with fairness and respect at all times Our plan must obey laws that protect you from discrimination or unfair treatment. We do not discriminate based on a person’s race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, or geographic location within the service area. If you want more information or have concerns about discrimination or unfair treatment, please call the Department of Health and Human Services’ Offi ce for Civil Rights 1-800-368-1019 (TTY 1-800-537-7697) or your local Offi ce for Civil Rights. 131
132 2013 Evidence of Coverage for PPO II Chapter 8: Your Rights and Responsibilities If you have a disability and need help with access to care, please call us at Customer Service (phone numbers are printed on the back cover of this booklet). If you have a complaint, such as a problem with wheelchair access, Customer Service can help. Section 1.3 We must ensure that you get timely access to your covered services and drugs You have the right to choose a provider in the plan’s network. Call Customer Service to learn which doctors are accepting new patients (phone numbers are printed on the back cover of this booklet). You also have the right to go to a women’s health specialist (such as a gynecologist) without a referral and still pay the in-network cost-sharing amount. As a plan member, you have the right to get appointments and covered services from your providers within a reasonable amount of time. Th is includes the right to get timely services from specialists when you need that care. You also have the right to get your prescriptions fi lled or refi lled at any of our network pharmacies without long delays. If you think that you are not getting your medical care or Part D drugs within a reasonable amount of time, Chapter 9, Section 10 of this booklet tells what you can do. (If we have denied coverage for your medical care or drugs and you don’t agree with our decision, Chapter 9, Section 4 tells what you can do.) Section 1.4 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. • Your “personal health information” includes the personal information you gave us when you enrolled in this plan as well as your medical records and other medical and health information. • Th e laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We give you a written notice, called a “Notice of Privacy Practice,” that tells about these rights and explains how we protect the privacy of your health information. How do we protect the privacy of your health information? • We make sure that unauthorized people don’t see or change your records. • In most situations, if we give your health information to anyone who isn’t providing your care or paying for your care, we are required to get written permission from you fi rst. Written permission can be given by you or by someone you have given legal power to make decisions for you. • Th ere are certain exceptions that do not require us to get your written permission fi rst. Th ese exceptions are allowed or required by law. � For example, we are required to release health information to government agencies that are checking on quality of care. � Because you are a member of our plan through Medicare, we are required to give Medicare your health information including information about your Part D prescription
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55 Water Street, New York, New York
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