Page 4 - Aegion Value Plan SPDs
P. 4
MEMBER RIGHTS AND RESPONSIBILITIES
As a Member You have rights and responsibilities when receiving health care. As Your health care partner,
the Claims Administrator wants to make sure Your rights are respected while providing Your health benefits.
That means giving You access to the Claims Administrator’s network health care Providers and the
information You need to make the best decisions for Your health. As a Member, You should also take an
active role in Your care.
You have the right to:
Speak freely and privately with Your health care Providers about all health care options and treatment
needed for Your condition no matter what the cost or whether it is covered under Your Plan.
Work with Your Doctors to make choices about Your health care.
Be treated with respect and dignity.
Expect the Claims Administrator to keep Your personal health information private by following the
Claims Administrator’s privacy policies, and state and Federal laws.
Get the information You need to help make sure You get the most from Your health Plan, and
share Your feedback. This includes information on:
- The Claims Administrator’s company and services.
- The Claims Administrator network of health care Providers.
- Your rights and responsibilities.
- The rules of Your health Plan.
- The way Your health Plan works.
Make a complaint or file an appeal about:
- Your health Plan and any care You receive.
- Any Covered Service or benefit decision that Your health Plan makes.
Say no to care, for any condition, sickness or disease, without having an effect on any care You may
get in the future. This includes asking Your Doctor to tell You how that may affect Your health now and
in the future.
Get the most up-to-date information from a health care Provider about the cause of Your illness, Your
treatment and what may result from it. You can ask for help if You do not understand this information.
You have the responsibility to:
Read all information about Your health benefits and ask for help if You have questions.
Follow all health Plan rules and policies.
Choose an In-Network Primary Care Physician, also called a PCP, if Your health Plan requires it.
Treat all Doctors, health care Providers and staff with respect.
Keep all scheduled appointments. Call Your health care Provider’s office if You may be late or need to
cancel.
Understand Your health problems as well as You can and work with Your health care Providers to make
a treatment plan that You all agree on.
Inform Your health care Providers if You don’t understand any type of care you’re getting or what they
want You to do as part of Your care plan.
Follow the health care plan that You have agreed on with Your health care Providers.
Give the Claims Administrator, Your Doctors and other health care Providers the information needed
to help You get the best possible care and all the benefits You are eligible for under Your health Plan.
This may include information about other health insurance benefits You have along with Your coverage
with the Plan.
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As a Member You have rights and responsibilities when receiving health care. As Your health care partner,
the Claims Administrator wants to make sure Your rights are respected while providing Your health benefits.
That means giving You access to the Claims Administrator’s network health care Providers and the
information You need to make the best decisions for Your health. As a Member, You should also take an
active role in Your care.
You have the right to:
Speak freely and privately with Your health care Providers about all health care options and treatment
needed for Your condition no matter what the cost or whether it is covered under Your Plan.
Work with Your Doctors to make choices about Your health care.
Be treated with respect and dignity.
Expect the Claims Administrator to keep Your personal health information private by following the
Claims Administrator’s privacy policies, and state and Federal laws.
Get the information You need to help make sure You get the most from Your health Plan, and
share Your feedback. This includes information on:
- The Claims Administrator’s company and services.
- The Claims Administrator network of health care Providers.
- Your rights and responsibilities.
- The rules of Your health Plan.
- The way Your health Plan works.
Make a complaint or file an appeal about:
- Your health Plan and any care You receive.
- Any Covered Service or benefit decision that Your health Plan makes.
Say no to care, for any condition, sickness or disease, without having an effect on any care You may
get in the future. This includes asking Your Doctor to tell You how that may affect Your health now and
in the future.
Get the most up-to-date information from a health care Provider about the cause of Your illness, Your
treatment and what may result from it. You can ask for help if You do not understand this information.
You have the responsibility to:
Read all information about Your health benefits and ask for help if You have questions.
Follow all health Plan rules and policies.
Choose an In-Network Primary Care Physician, also called a PCP, if Your health Plan requires it.
Treat all Doctors, health care Providers and staff with respect.
Keep all scheduled appointments. Call Your health care Provider’s office if You may be late or need to
cancel.
Understand Your health problems as well as You can and work with Your health care Providers to make
a treatment plan that You all agree on.
Inform Your health care Providers if You don’t understand any type of care you’re getting or what they
want You to do as part of Your care plan.
Follow the health care plan that You have agreed on with Your health care Providers.
Give the Claims Administrator, Your Doctors and other health care Providers the information needed
to help You get the best possible care and all the benefits You are eligible for under Your health Plan.
This may include information about other health insurance benefits You have along with Your coverage
with the Plan.
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