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Member Rights and Responsibilities

Members are informed of their rights and responsibilities through the Member Handbook. NH Healthy Families network providers are also expected to respect and honor member’s rights.

Rights

  • You have the right to receive information in an easily understandable and readily accessible format that meets your needs. 
  • You have the right to be treated with respect and with due consideration for your dignity and right to privacy.
  • You have the right to receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
  • You have the right to participate in decisions regarding your health care, including the right to refuse treatment.
  • You have the right to receive information about the organization, its services, its practitioners and providers and member rights and responsibilities.
  • You have the right to voice complaints or appeals about the organization or the care it provides, and ask us to reconsider decisions that have been made.
  • You have the right to make recommendations regarding the organization’s member rights and responsibilities policy.
  • You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • You have the right to see, as well as request and receive a copy of your medical records at no cost to you, and the right to request that your medical records be amended or corrected.
  • You have the right to covered services and drugs that are available and accessible in a timely manner.
  • You have a right to care coordination.
  • You have the right to privacy and protection of your personal health information.
  • You have the right to receive information about our plan, our network providers, and your covered services.
  • You have the right to request and receive any written provider incentive plans.
  • You have the right to certain benefits, including Family Planning Services and supplies, from non-participating providers.
  • You have the right to participate with practitioners in making decisions about your health care.
  • You cannot be retaliated against in any way by the plan or by the New Hampshire Department of Health and Human Services (NH DHHS) for exercising your rights.
  • You have the right to a second opinion. 
  • You have the right to know what to do if you are being treated unfairly or your rights are not being respected. 
  • You have the right to be informed of any changes in state law that may affect your coverage. The plan will provide you with any updated information at least 30 calendar days before the effective date of the change whenever practical.
  • You have the right to exercise advance care planning for your health care decisions if you so choose. 
  • You have the right to make a complaint if a provider does not honor your wishes expressed in your advance directive. 
  • You have the right to leave our plan in certain situations. 
  • You have right to a candid discussion of appropriate or medically necessary treatment options for you conditions, regardless of cost or benefit coverage. In the case of a counseling or referral service that we do not cover because of moral or religious objections, we must inform you that the service is not covered and how you can obtain information on how to access this service.
  • You are free to exercise your rights, and the plan shall assure that the exercise of those rights shall not adversely affect the way plan and its providers or DHHS treat you.
  • Information provided by us will reflect changes in State law as soon as possible, but no later than ninety (90) calendar days after the effective date of the change

Responsibilities

  • You have the responsibility to supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
  • You have the responsibility to follow plans and instructions for care that you have agreed to with your practitioners.
  • You have the responsibility to understand your health problems and to participate in developing mutually agreed upon treatment goals with your provider to the highest degree possible.
  • You have the responsibility to get familiar with your covered services and the rules you must follow to get these covered services. 
  • You have the responsibility to tell us if you have any other health insurance coverage or prescription drug coverage in addition to our plan as soon as possible.
  • You have the responsibility to tell your doctor and other health care providers that you are enrolled in our plan. 
  • You have the responsibility to help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
  • You have the responsibility to request interpretation services if you need them. Our plan has staff and free language interpreter services available to answer questions from non-English speaking members. 
  • You have the responsibility to respect other members, plan staff and providers.
  • You have the responsibility to pay what you owe. A
  • You have the responsibility to tell us if you move. If you are going to move or have moved, it is important to tell us as soon as possible.
  • You have the responsibility to NOT allow anyone else to use your NH Healthy Families or New Hampshire Medicaid membership cards. 
  • You have the responsibility to call Member Services for help if you have questions or concerns. We also welcome any suggestions you may have for improving our plan.