Tools To Make The Most Of Your Health Plan


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Member Rights and Responsibilities

Member Rights

To choose: Members have the right to choose a personal physician from Unity’s network of Primary Care Physicians (PCPs).

To obtain information: Members have the right to receive information about their rights and responsibilities as a member of Unity. Members have the right to make recommendations regarding Unity’s Member Rights and Responsibilities Statement. Members have the right to obtain information about Unity and information relating to covered and excluded health plan benefits. Members also have the right to obtain information on available primary and specialty care
practitioners and providers. Members have the right to receive preventive care information and information about their illnesses and treatment options. Members have the right to obtain information about how to file a complaint, appeal, or grievance.

To have privacy and confidentiality: Members have the right to privacy and confidentiality in communications and records about their care.

To participate in their care: Members have the right to be active in decisions about their treatments. Members have the right to have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.  Members have the right to obtain information about the risks and benefits of treatment. Members also have the right to refuse care.

To present a complaint, appeal, or grievance: Members have the right to voice concerns and to receive a prompt and fair review of their concerns.

To be treated with respect and dignity: Members have the right to be treated with respect and dignity regardless of their race, age, gender, sexual orientation, or creed.

Member Responsibilities

To choose a personal physician:  Members have a responsibility to choose a personal physician from among Unity’s network of PCPs and to establish a relationship with that physician.

To know their benefits and requirements:  Members have a responsibility to understand their health plan benefits and limitations and to follow required procedures.  Members also have a responsibility to know how to use Unity’s provider network and to ask questions about things they do not understand.

To provide accurate information:  Members have a responsibility to provide accurate and complete information about their health history, their eligibility, and their enrollment. Members have a responsibility to show their ID card each time they receive services and to pay any out-of-pocket expenses they incur.

To participate in their care: Members have a responsibility to participate in their care by asking questions about their health. Members also have a responsibility to follow the recommended and agreed upon treatment plan for their illness, and to make healthy lifestyle choices to maintain their health or
manage their illness.

To keep their appointments:  Members have a responsibility to keep their appointments or to give early notice if they must cancel.

To show consideration and respect: Members have a responsibility to show consideration and respect to health plan staff and health care providers.