Member Rights and Responsibilities

Scott & White Health Plan is committed to treating members in a manner that respects their rights. We also have expectations of what our members' responsibilities are concerning their healthcare coverage. The following is our policy concerning our members' rights and responsibilites.

Rights:

• You have the right to be provided with information about Scott & White Health Plan, its services, and the providers and practitioners giving your care.
• You have the right to receive information regarding your member rights and responsibilities.
• You have the right to be treated with respect and recognition of your dignity and right to privacy.
• You have the right to participate in decision-making regarding your healthcare.
• You have the right to a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• You have the right to voice complains, appeals or grievances about your coverage through the Scott & White Health Plan or the care provided by Plan providers in accordance with your Healthcare Agreement.
• You have the right to make recommendations regarding Scott & White Health Plan’s member rights and responsibilities policies.
• You have the right to have an advance directive, such as a Living Will or Durable Power of Attorney for Healthcare Directive.  These documents express your choices about your future care or name someone to decide if you cannot speak for yourself.
• You have the right to expect that medical information is kept confidential in accordance with your Healthcare Agreement.

Responsibilities:

• It is your responsibility to choose a primary care physician (PCP) and to notify Scott & White Health Plan Customer Service of any change in PCP selection.
• It is your responsibility to notify Scott & White Health Plan regarding any out-of-Plan care.
• It is your responsibility to follow Scott & White Health Plan instructions and rules and abide by the terms of your Healthcare Agreement.
• It is your responsibility to provide information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
• It is your responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
• It is your responsibility to follow plans and instructions, to the best of your ability, for care that you have agreed on with your practitioner(s) and provider(s).
• It is your responsibility to give Plan providers a copy of an advance directive, if one exits.
• It is your responsibility to advise Scott & White Health Plan or Plan providers of any dissatisfaction you may have in regard to your care while a patient, and to allow the opportunity for intervention to alter the outcome whenever possible.
  

July 1995 SWHP 267 (revised June 2007)

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