Blue Plus members
Your rights as a health plan member:
- To get quality health care that is timely, accessible, and friendly.
- To be treated with respect, dignity and consideration for privacy.
- To get medically necessary covered services, including emergency services, 24 hours a day, seven (7) days a week.
- To be told about your health problems.
- To get information about treatments, your treatment choices and how they will help or harm you - whether or not the health plan would pay for these treatments.
- To participate with your providers in the decisions about your health care.
- To participate in understanding your health problems and developing your treatment goals.
- To refuse treatment. To get information about what might happen if you refuse treatment.
- To refuse care from specific providers.
- To expect that we will keep your medical and financial records private according to the law.
- To request and receive a copy of your medical records. You also have the right to ask to correct the records.
- Get notice of our decisions if we deny, reduce or stop a service, or deny payment for a service.
- To file a grievance or appeal with Blue Plus. You can also file a complaint with the Minnesota Department of Health.
- To request a State Fair Hearing with the Minnesota Department of Human Services (also referred to as "the State"). You may request a State Fair Hearing before or at any time during the Blue Plus appeal process. You do not have to file an appeal with Blue Plus before you request a State Fair Hearing.
- To get a clear explanation of covered nursing home and home care services.
- Give written instructions that inform others of your wishes about your health care. This is called a "health care directive." It allows you to name a person (agent) to decide for you if you are unable to decide, or if you want someone else to decide for you.
- To choose where you will get family planning services.
- To get a second opinion for medical, mental health and chemical dependency services.
- To be free of restraints or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- To request a copy of this Certificate of Coverage at least once a year.
- To recommend changes regarding Blue Plus' rights and responsibilities policies.
- To freely exercise your rights. The exercise of your rights will not adversely affect the way you are treated.
Get the following information from us, if you ask for it:
- whether we use a physician incentive plan that affects the use of referral services;
- the type(s) of incentive arrangement used;
- whether stop-loss protection is provided; and
- results of a member survey if one is required because of our physician incentive plan.
Get the results of an external quality review study from the state, if you ask for them.
- To be told when a health care provider cancels their contract with Blue Plus. You may choose from the rest of the Blue Plus providers.
- To have a person at Blue Plus or at the clinic to contact with any concerns about services.
- To get information about Blue Plus, our services, network of providers, and your rights and responsibilities.
- To start a legal proceeding when having a problem with Blue Plus or our providers.
- To file a grievance or appeal with Blue Plus and receive a fair and prompt review.
- To contact the state ombudsman for help in filing a grievance or appeal.
- To ask for a speedy hearing.
Your responsibilities as a health plan member:
- Read this Certificate of Coverage and know which services are covered under the Plan and how to get them.
- To show your member ID card and your Minnesota Health Care Programs card every time you go for health care. Also show the cards of any other health coverage you have, such as Medicare or private insurance.
- To establish a relationship with a Blue Plus primary care doctor before you become ill. This helps you and your primary care doctor understand your total health condition.
- To give information that Blue Plus and our providers need to give care to you. Share information about your health history.
- To follow all of your doctor’s instructions. If you have questions about your care, you should ask your doctor.
- Work with your doctor to understand your total health condition. It is important to know what to do when a health problem occurs, when and where to seek help, and how to prevent heath problems.
- To practice preventive health care. To have tests, exams and shots recommended for you based on your age and gender.
- To tell the clinic about changes in your name or address.
- To keep appointments for care or to give early notice if you need to cancel.