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Member Rights and Responsibilities

Members have a right to:

  • Information about Health Advantage
  • An explanation of their benefits
  • Access to healthcare providers
  • Be treated with respect and dignity
  • Participate in decisions regarding their healthcare coverage and communicate their preferences
  • Confidentiality of information
  • Change healthcare providers
  • Appeal adverse claim decisions

Members have a responsibility to:

  • Become familiar with the terms, requirements and procedures of their health insurance plan
  • Present their member ID card to healthcare providers when seeking care
  • Provide information in connection with their submitted claims, including information about other healthcare coverage, when requested by Health Advantage
  • Meet all copayments, deductible and coinsurance obligations
  • Notify Health Advantage of any change in eligibility status
  • Communicate to Health Advantage any complaint or grievance immediately

NOTE: Information on Member Rights and Responsibilities is provided annually in our member magazine, Blueprint.