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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

  • To receive information about NH Healthy Families, its benefits, its services, its network providers and its member rights and responsibilities.
  • To be treated with respect and with due consideration for your dignity and the right to privacy and non-discrimination as required by law.
  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s ability to understand.
  • To participate with your providers in making decisions regarding your healthcare, including the right to refuse treatment.
  • To voice grievances or file appeals about NH Healthy decisions that affect your privacy, benefits, or the care provided.
  • To make recommendations regarding NH Healthy Families member rights and responsibilities policies.
  • To complete information about their specific condition and treatment options, regardless of cost or benefit coverage.
  • To seek second opinions.
  • To obtain information about available experimental treatments and clinical trials and how such research can be accessed.
  • To obtain assistance with care coordination from the PCP’s office.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in the Federal regulations on the use of restraints and seclusion.
  • To express a concern or appeal about NH Healthy Families or the care it provides and receive a response in a reasonable period of time.
  • To be able to request and receive a copy of his/her medical records, (one copy free of charge) and request that they be amended or corrected.
  • To choose his/her health professional to the extent possible and appropriate, in accordance with 42 CFR §438.6(m).
  • To receive health care services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid FFS and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
  • To receive all information— e.g., enrollment notices, informational materials, instructional materials, available treatment options and alternatives.—in a manner and format that may be easily understood as defined in the Provider Agreement and this Member Handbook.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
  • To be notified that interpretation services are available and how to access those services.

Responsibilities

  • To provide information (to the extent possible) that NH Healthy Families providers need in order to provide care.
  • To inform NH Healthy Families of the loss or theft of an ID card.
  • Present the NH Healthy Families ID card when using healthcare services.
  • Be familiar with NH Healthy Families procedures to the best of the member’s abilities.
  • To call or contact NH Healthy Families to obtain information and have questions clarified.
  • To provide participating network providers with accurate and complete medical information.
  • To follow the prescribed treatment (plans and instructions) for care that has been agreed upon with your providers.
  • To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  • To make every effort to keep any agreed upon appointments, and follow-up appointments; and accessing preventive care services.
  • To live healthy lifestyles and avoid behaviors known to be detrimental.
  • To provide accurate and complete information to all health care providers.
  • To become knowledgeable about NH Healthy Families coverage provisions, rules and restrictions.
  • To ask questions of providers to determine the potential risks, benefits, and costs of treatment alternatives, and then making care decisions after carefully weighing all pertinent factors.
  • To follow the grievance process established by NH Healthy Families (and outlined in the Member Handbook) if there is a disagreement with a provider.