Member Rights And Responsibilities

A Member Shall Have the Right to:

  • Receive information about OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan), available programs and services, doctors, Providers, health care facilities, and drug coverage and costs, in a manner the Member will understand;

  • Be treated with dignity and respect at all times;

  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, or retaliation, or convenience;

  • Receive health care services without discrimination based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, sexual orientation, genetic information, evidence of insurability, or geographic location within the service area;

  • Have his or her personal and health information kept private;

  • Have timely access to covered services, including doctors, specialists, hospitals, and medications;

  • Receive emergency care where and when it is needed;

  • Know and understand his or her medical treatment choices/options and risks; participate in decisions about his or her health care, including the option to refuse care; and receive an explanation if coverage for care is denied;

  • File complaints, including complaints about quality of care; to ask for reconsideration of decisions CalOptima Cal MediConnect has made; and to be informed of procedures for filing Complaints, Appeals, and Grievances;

  • Be fully informed of all procedures for service authorization, quality assurance programs, disenrollment, and other procedures that may affect his or her access to care;

  • Select a Primary Care Provider (PCP) from a panel and request relevant credentialing information regarding a PCP;

  • Request a Second Opinion;

  • Receive information regarding Advance Directives;

  • Access his or her Medical Records, and have the confidentiality of his or her Medical Records protected; and request that the Medical Records be amended or corrected, in accordance with CalOptima Policy MA.9207: Member Request to Amend Record;

  • Make recommendations regarding the OneCare Connect Member rights and responsibilities policy;

  • Reasonable accommodations;

  • Not face negative consequences for exercising their rights;

  • Not be balance billed for covered services;

  • Get more information about your rights; and

  • Leave the plan at any time.

A Member Shall Have the Responsibility to:

  • Become familiar with OneCare Connect covered services and the rules that must be followed to get those services;

  • Inform OneCare Connect of any other health insurance or prescription drug coverage the Member has in addition to OneCare Connect;

  • Tell his or her health care providers that he or she is enrolled in OneCare Connect;

  • Learn about his or her medical condition and what keeps him or her healthy;

  • Actively participate in the health care programs that keep him or her well, including following the treatment plans and instructions that the Member and his or her doctors agree upon;

  • Inform his or her PCP of his or her medical condition and any medications the Member is taking;

  • Make and keep appointments for check-ups, and inform the PCP’s office when he or she must cancel an appointment;

  • Carefully review, understand, and follow the guidelines in the OneCare Connect Member Handbook/Evidence of Coverage (EOC) provided to all Members;

  • Be considerate, and respect the rights of other patients in a way that helps the smooth running of the Member’s doctor’s office, hospitals, and other offices;

  • Inform OneCare Connect of a change in permanent residence; and

  • Call Customer Service for help with questions or concerns.

To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H8016_19MM027_M Accepted (09/25/18)

OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations, co-pays, and restrictions may apply. For more information, call OneCare Connect Customer Service or read the OneCare Connect Member Handbook. Benefits and/or copayments may change on January 1 of each year. Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details. Other Pharmacies/Physicians/Providers are available in our network. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. OneCare Connect complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. You can get this information for free in other languages. Call toll-free 1-855-705-8823. TDD/TTY users can call 1-800-735-2929. The call is free.

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