Understanding your rights and responsibilities as a plan member can help you and us make the most of your membership. Below, we have listed your rights, or what you can expect of us, as well as your responsibilities, or what we expect from you.
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Enhanced Care (Medicaid Managed Care) Member Rights and Responsibilities
As a member of EmblemHealth Enhanced Care, you have a right to:
- Be cared for with respect, without regard for health status, sex, race, color, religion, national origin, age, marital status or sexual orientation.
- Be told where, when and how to get the services you need from EmblemHealth Enhanced Care.
- Be told by your PCP what is wrong, what can be done for you, and what will likely be the result in language you understand.
- Get a second opinion about your care.
- Give your OK to any treatment or plan for your care after that plan has been fully explained to you.
- Refuse care and be told what you may risk if you do.
- Get a copy of your medical record, and talk about it with your PCP, and to ask, if needed, that your medical record be amended or corrected.
- Be sure that your medical record is private and will not be shared with anyone except as required by law, contract, or with your approval.
- Use the EmblemHealth Enhanced Care complaint system to settle any complaints, or you can complain to the New York State Department of Health or the local Department of Social Services any time you feel you were not fairly treated.
- Use the State Fair Hearing system.
- Appoint someone (relative, friend, lawyer, etc.) to speak for you if you are unable to speak for yourself about your care and treatment.
- Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.
- Ask practitioners the verbal and written language services including languages spoken by the practitioner and office staff.
- Know how information about race, language, ethnicity, gender orientation, and sexual identity, gender, pronouns are collected and used, and the right to not provide this information.
As a member of EmblemHealth Enhanced Care, you agree to:
- Work with your PCP to guard and improve your health.
- Find out how your health care system works.
- Listen to your PCP’s advice and ask questions when you are in doubt.
- Call or go back to your PCP if you do not get better or ask for a second opinion.
- Treat health care staff with the respect you expect yourself.
- Tell us if you have problems with any health care staff. Call Member Services.
- Keep your appointments. If you must cancel, call as soon as you can.
- Use the emergency room only for real emergencies.
- Call your PCP when you need medical care, even if it is after-hours.
- As appropriate for care, ask practitioners their willingness to identify their race and ethnicity.
Members have the right to know how information is collected and used, and to not provide information about race, language, ethnicity, sexual orientation, gender identity, gender, and pronouns.
This information is collected through enrollment information, self-disclosure, and the member portal. They are used to assess health care disparities, design intervention programs, and design and direct outreach materials, and they inform health care practitioners and providers about individuals’ needs. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. Member race, language, ethnicity, sexual orientation, and gender identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits) and cannot be disclosed to unauthorized users. EmblemHealth limits and terminates access to information by employees who are not or no longer authorized to have access. Information is protected as outlined in EmblemHealth’s policies. Network providers and practitioners are also contractually obligated to protect the confidentiality of members’ information.
In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. Information is protected as stated in EmblemHealth’s policies.
JP 63162 1/2024
