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As a valued Cox HealthPlans member, you are entitled to certain rights and services. As a member, there are also responsibilities in your health care. If you acquaint yourself with and follow these steps when you receive medical services, our performance as your health insurance company will be enhanced.

AS A MEMBER, YOU HAVE THE RIGHT TO:

  • Receive information about the organization and its services, practitioners and Providers, and Member rights and responsibilities.
  • Be treated with respect, consideration, recognition of your dignity, and right to privacy.
  • Participate with practitioners in making decisions about your health care.
  • Discuss appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • Be informed about, and refuse to participate in any experimental treatment.
  • Be informed about applicable fees and payment policies.
  • Change your Primary Care Provider (PCP). Your plan does not require the designation of a PCP; however we encourage you to select a PCP to assist in coordinating your care.
  • Get information about Cox HealthPlans, our services, network providers, and the credentials of health care professionals.
  • Receive complete information concerning a medical evaluation, diagnosis, treatment, and prognosis from your provider.
  • Voice complaints or appeals about the organization or the care it provides.
  • Make recommendations regarding the Plan’s member rights and responsibilities policy.
  • Receive the Benefits to which you are entitled under your Health Plan and Schedule of Benefits.
  • Access wellness information to help you maintain a healthy lifestyle.
  • Designate or authorize another party to act on your behalf, regardless of whether you are physically or mentally incapable of providing consent.
  • Interpretive Services as necessary. Non-English-speaking Members can contact the same Member Services telephone number printed on the back of the ID Card to connect to a language services interpreter.
  • Privacy and confidential handling of your disclosures and records. You may approve or refuse their release, except when the release is required by law.
  • Cox HealthPlans is committed to protecting the confidentiality and security of health information. A complete privacy statement is provided on an annual basis. It is also accessible at any time on our website at www.coxhealthplans.com.
  • Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
  • Provide an accurate health history, including information about medications and over-the-counter products,
    dietary supplements, and allergies or sensitivities.
  • Follow plans and instructions for care that you have agreed to with your practitioners.
  • Take part in understanding your health problems and participate in mutually agreed-upon treatment goals, to the degree possible.
  • Use Providers who will provide or coordinate your total health care needs, and to maintain an ongoing
    patient-Physician relationship.
  • Present your current ID Card each time you receive a medical/pharmaceutical service.
  • Inform providers about living wills, medical power of attorney, or other directives affecting care.
  • Treat healthcare providers, staff, and others, with respect.
  • Know your Provider Network and verify the Provider’s status at your time of service.
  • Follow up with your Provider to verify Preauthorization is obtained as required by your Health Plan.
  • Read and understand your Health Plan and Schedule of Benefits and other materials from us concerning your health Benefits.
  • Understand how to access care in routine, Emergency, and Urgent situations; and to know your health care Benefits as they relate to out-of-area coverage, Deductible/ Co-insurance/ Co-payments, etc.
  • Know the limitations and exclusions of your Health Plan.
  • Provide timely, accurate, and complete information to us about other health care coverage and/or insurance Benefits you may carry as it pertains to your plan.
  • Accept personal fiscal responsibility for costs not covered by insurance if applicable.
  • Inform us of changes affecting your coverage including but not limited to your name, address, telephone number, and family status.
  • Contact our Member Services Department when you have a question concerning your coverage or experience a problem.