Member rights and responsibilities
As a member, you are entitled to certain rights and services. You also have a responsibility to participate in your health care. A good partnership between you and your health care provider will enhance our ability to provide appropriate services and your ability to receive the maximum benefit from services. Here is a summary of your rights and responsibilities as a member.
Member rights
1. Members have the right to receive information about their health plan, its practitioners and providers and members’ rights and responsibilities.
2. Members have the right to courteous treatment. We respect your right to:
- Be treated with respect and recognition of your dignity. We will not discriminate in the care offered to you based on race, religion, national origin, sex, age, sexual preference, type of illness or financial status.
- Be addressed in a manner that is comfortable to you.
- Know your health care providers. You have the right to ask all personnel involved in your care to introduce themselves, state their positions and explain what they are going to do for you.
3. Members have the right to available and accessible services, including emergency services. Responsibility for payment for such services will be determined by your plan’s coverage.
4. Members have the right to privacy. Plan providers are required to respect the privacy of all members. Case discussions, examinations and treatment are confidential and conducted discreetly.
5. Members have the right to a candid discussion of appropriate or medically-necessary treatment options for their conditions, regardless of cost or benefit coverage.
6. Members have the right to be informed about their health care and to receive information about proposed treatments and alternatives. Members have the right to an explanation from health care provider(s) of:
- Diagnosis
- Recommended treatment and alternatives to treatment
- Potential outcomes and/or prognosis
- Significant benefits and risks of each alternative
You may choose to include family members or friends in this discussion.
7. Members have the right to participate with providers in making decisions about their care. These rights generally include:
- Giving informed consent, i.e., agreeing to treatment based on a full explanation of your disease and the risks and benefits of proposed treatment, as well as alternative treatments
- Refusing diagnostic procedures or treatment. It is your right to decide whether you wish to be treated and, if so, by which method of treatment.
You may be treated without consent under certain circumstances, including in an emergency and when immediate action must be taken. The consent of a legal guardian may be required if you are a minor, unconscious or unable to give consent.
8. Members have the right to appropriate confidentiality of all medical and financial records in accordance with state and federal law. Generally, your medical records will not be released to persons outside your health plan unless you grant permission in writing, or we are required or permitted, under applicable law, to use or release this information. Certain examples of permitted releases of information are:
- If required by a court order
- To medical personnel in a medical emergency
- As necessary to facilitate complaint Investigations or inspections by the Minnesota Department of Health
- To qualified personnel for research, audit or program evaluation, as long as individuals cannot be identified
9. Members have a right to voice complaints or appeals about their health plan or the care provided. Members who belong to fully-insured plans have the right to file a grievance with HealthPartners and/or the Minnesota Commissioner of Health.
10. Members have the right to make recommendations regarding the plan’s member rights and responsibilities.
Member responsibilities
1. Members have the responsibility to ask for clear explanations. If the explanation of your medical problem or treatment plan is not clear, ask for the information you need. You may also want to ask:
- Why a treatment is recommended
- What alternatives are available
- If the treatment is new or experimental
- If the treatment causes discomfort or pain
- How long the treatment will take
- What risks or side effects are involved
- About the credentials of the person providing treatment
2. Members have the responsibility to understand their health problems and to participate in developing mutually agreed upon treatment goals to the greatest degree possible. Once members and their health care provider(s) have agreed upon a treatment plan, it is the member’s responsibility to follow the prescribed plan and instructions for care. Advise the health care provider treating you if you are unable to follow a treatment plan.
3. Members have the responsibility to make informed decisions. Because you are responsible for the decisions you make about your care, we encourage you to gather as much information as you need to make your decisions.
You may be asked to consent in writing to certain tests, procedures or operations. Ask as many questions as you need to fully understand each document you are asked to sign. If you change your mind or refuse a treatment, discuss your reasons with your health care provider.
4. Members have the responsibility to be honest and to provide, to the extent possible, information that the health plan needs to administer plan benefits and its providers need to provide care. Provide an accurate and complete medical history. Tell those who are caring for you exactly how you feel about the things that are happening to you.
5. Members have the responsibility to understand or to ask further questions when they do not understand. If you do not understand your illness or your treatment, ask your health care provider to explain it to you.
6. Members have the responsibility to report changes in their health. Tell your doctor about any changes in your health.
7. Members have the responsibility to know their medications. Know or write down the names and purposes of the medications you have taken recently.
8. Members have the responsibility to know their providers. Try to know the names and the positions of everyone who cares for you (doctors, dentists, nurses, etc.). Also know the names and addresses of your previous health care providers.
We understand that you may be faced with making critical treatment choices while you are under the care of a HealthPartners provider. We respect your right to make individual decisions based on your personal beliefs and values as well as on the available medical information.