Member Rights and Responsibilities

What are your health care rights?

You have the right to know

  • Know your rights and responsibilities
  • Know about our services, doctors, and specialists and be informed when your doctor is no longer contracted with Care1st Health Plan
  • Know about all our other caregivers
  • Be able to see your medical records. You have to follow the State and Federal laws that apply
  • Have an honest talk with your doctor about all treatment options for your condition, regardless of cost or benefit coverage

You have the right to be treated well

  • Always be treated with respect
  • Have your privacy kept safe by everyone in our health plan
  • Know that we keep all your information private

You have the right to be in charge of your health care

  • Choose your primary care doctor
  • Say no to care from your primary care doctor or other caregivers
  • Be able to make choices about your health care
  • Make a living will (also called an advance directive)
  • Voice complaints or appeals about Care1st or the care it provides including the right to file a grievance if you do not receive services in the language you request.

You have the right to get a range of services

  • Get family planning services
  • Get preventative health care services
  • Get minor consent services
  • Be treated for sexually transmitted diseases (STDs)
  • Get emergency care outside of our network
  • Get health care from a Federally Qualified Health Center (FQHC)
  • Get health care at an Indian Health Center
  • Get a second opinion
  • Get interpreter services at no cost. This includes services for the hearing-impaired
  • Get informing materials in various languages or alternative formats and large size print upon request

You have the right to suggest changes to our health plan

  • Tell us what you don’t like about our health plan
  • Tell us what you don’t like about the health care you get
  • Question our decisions about your health care
  • Tell us what you don’t like about our right and responsibilities policy
  • Ask the Department of Social Services for a Fair Hearing
  • Ask the Department of Managed Health Care for an Independent Medical Review
  • Choose to leave our health plan.

What are your responsibilities as a health care member?

We hope you will work with your doctors as partners in your health care

  • Make an appointment with your doctor within 120 days of becoming a new member for an initial health assessment
  • Tell your doctors what they need to know to treat you
  • Learn as much as you can about your health
  • Follow the treatment plans you and your doctors agree to
  • Follow what the doctor tells you to do to take good care of yourself
  • Do the things that keep you from getting sick
  • Bring your ID card with you when you visit your doctor
  • Treat your doctors and other caregivers with respect
  • Use the emergency room for emergencies only. Your doctor will provide most of the medical care that you need
  • Report health care fraud.

We want you to understand your health plan

  • Know and follow the rules of your health plan
  • Know that laws guide our health plan and the services you get
  • Know that we can’t treat you different because of, age, sex, race, national origin, culture, language needs, sexual orientation and/or health.