UniCare HMO Member Rights and Responsibilities Statement
UniCare HMO is committed to maintaining a mutually respectful relationship with our members and at the same time we expect our members to assume certain responsibilities. Members' Rights and Responsibilities are described below.
You have the right to:
- Receive clear and accurate information about UniCare HMO and your benefits, your rights and responsibilities, information on all of the services offered to you and how and when you can use them.
- To receive the names of the participating doctors, hospitals, pharmacies, and other health care providers and health care places you have available to you.
- Be treated with respect and with dignity, to have your personal health information be kept secure and confidential, and you have a right to your privacy.
- Be involved with doctors and other health care professionals in the decision-making process regarding your health care.
- Talk over your health care needs with the health care professionals caring for you, and to have a clear and open talk with them about appropriate or medically necessary care available for your condition, regardless of cost or whether it is covered by your health plan benefits.
- Be informed of your diagnosis, treatment and prognosis in terms you understand.
- Refuse treatment and be informed of the probable consequences of your actions.
- To receive appropriate information so that you may give informed voluntary consent to participate in experimental research. However, experimental and investigational procedures are not covered under your plan.
- Have your guardian, next of kin or legally authorized person exercise your rights on your behalf if your medical condition makes you incapable of understanding or exercising your rights.
- Receive advice or assistance in a prompt, courteous, and responsible manner.
- Be given the first name of any staff involved in your care and you may speak with their supervisor if desired.
- Refuse to take part in any UniCare sponsored health care activity or program, or you may leave the program at any time. If you decide to take part in an activity or program, you will be told of any changes.
- Receive from UniCare HMO a description of the financial relationships between it and independently contracted health care providers and the percent of premiums spent on health care-related and administrative expenses.
- Ask your health care provider for: a) information related to the provider's education background, experience, training, specialty, and board certification, if applicable; b) the names of the licensed facilities where the provider has privileges for your treatment; and c) information about the provider's participation in continuing education programs and compliance with any licensure, certification, or registration requirements, if applicable.
- Make a written or spoken suggestion or complaint about the care you received from a participating independently contracted health care professional or provider, or about the service you received from your health plan, and you may appeal any decision about your health care benefits.
- Write to UniCare with ideas or questions about this statement on member rights and responsibilities. Your letter can be sent to the Quality Management Department at UniCare, 233 S. Wacker Drive, Suite 3900, Chicago, IL 60606.
- To be certain your health records are kept confidential except when disclosure is required by law or permitted in writing by you. With adequate notice, you have the right to review your medical records with your physician.
To help participating health care professionals and providers in meeting their responsibilities to you, it is your duty to:
- Give patient identification and medical information, to the best of your ability, that your health care professionals and providers need in order to care for you.
- Give patient identification and medical information, to the best of your ability, that your health plan needs in order to provide service to you.
- Follow the prescribed medical plan and health care instructions that you have agreed upon with your doctor or other health care professional and tell him/her if you decide to take part in any UniCare sponsored health care activity or program.
- To the best of your ability, work with your doctor to be aware of and understand your health problems and participate in developing your health care treatment goals.
- Coordinate your health care through your primary care doctor.
- Read and follow directions in the UniCare HMO Member Handbook.
- Keep your appointments or tell your doctor's office ahead of time if you will be late or need to cancel.
- Pay any applicable co-pays at the time you receive service.
- Understand what medications you are taking and whether follow-up care is needed.
- Treat those caring for you with respect and courtesy.
- Express your opinions, concerns, or complaints in a constructive manner to the appropriate people within UNCARE or the provider network.
- Provide member consent to UniCare as needed by law, when you have decided to sign up for a UniCare sponsored activity or program.
© 2005 UniCare