Member Rights and Responsibilities

At Blue Cross Community MMAI (Medicare-Medicaid Plan)^SM, we want to make sure you get the health care you need. We also want to make sure your rights as a member are respected.

Your Rights

You have the right to respect, fairness and dignity.

This includes:

• The right to get covered services without concern about race, ethnicity, national origin religion, gender, age, mental or physical disability, sexual orientation, genetic information, ability to pay or ability to speak English

You have the right to get information about your health care.

This includes:

• The right to information on treatment and your treatment options in a format you understand.

You have the right to make decisions about your care, including refusing treatment.

This includes:

• The right to stop taking medicine
• The right to ask for a second opinion. The plan will pay for your second opinion visit

You have the right to timely access to care that does not have any communication or physical access barriers.

This includes:

• The right to get in and out of a health care provider's office. This means second opinion visit access for people with disabilities, in accordance with the Americans with Disabilities Act
• The right to have interpreters help with communication with your doctors and your health plan

You have the right to seek emergency and urgent care when you need it.

This includes:

• The right to get emergency services without prior approval in an emergency
• The right to see an out-of-network urgent or emergency care provider, when necessary

You have a right to confidentiality and privacy.

This includes:

• The right to have your personal health information kept private

You have the right to make complaints about your covered services or care.

This includes:

• The right to file a complaint or grievance against us or our providers

Your Responsibilities

• To give complete health information to help your doctor give you the care you need
• To follow treatment instructions for medication, diet and exercise as agreed upon by you and your doctor
• To take part in coming up with treatment goals with your doctor
• To keep your appointment – or call at least 24 hours before if you need to reschedule or cancel
• To show your ID card before getting health care services (or you may be billed for the service)
• Tell us if you move.
  • If you move outside of our service area, you cannot stay in this plan.
  • If you move within our service area, we still need to know.

Members that are asked to leave the Blue Cross Community MMAI plan, otherwise known as Involuntary Disenrollment, have the following rights:

• Upon disenrollment, you have the right to be notified in writing of the upcoming involuntary disenrollment and an explanation why such action is occurring
• You also have the right to file a formal grievance or complaint as outlined above on this page
• You may NOT file a grievance if you were asked to leave the Blue Cross Community MMAI plan due to death or because you lost your eligibility for Medicare Parts A and/or B

Reasons you may be asked to leave the Blue Cross Community MMAI plan:

• It is determined that you have other significant insurance coverage
• You no longer permanently reside in the plan's service area; EXCEPT
  • If you live in the plan’s service area and are admitted to a Nursing Facility outside the plan’s service area and placement is not based on your family or social situation
• You no longer meet the eligibility requirements described on the How to Enroll page

For a complete list of member rights and responsibilities, visit the Forms & Documents page to see the full Member Handbook.