Certain health plans that were in effect prior to March 23, 2010 may be "grandfathered health plans" under the Patient Protection and Affordable Care Act. If your plan is grandfathered, then your plan will include some consumer protections from the Affordable Care Act, but may not include other protections that apply to non-grandfathered health plans. If your plan is a grandfathered health plan, notice indicating that fact will be contained in your Certificate Booklet or your group's summary plan description.
Please click here to select your State and review your Medical Policies.
- Please go to empireblue.com/privacy for information about our policies and procedures for the collection, use and disclosure of your protected health information (PHI). This includes, but not limited to information about routine notification of privacy practices, use of authorization, your access to medical records, protection of verbal, written and electronic information, information for employers, and more.
As a member, you have rights and responsibilities when receiving healthcare. As your healthcare partner, we want to make sure your rights are respected, while providing your health benefits. That means giving you access to our network of doctors and healthcare professionals, who help you make the best decisions for your health.
You have the right to:
- Speak freely and privately with your doctors and other healthcare professionals about healthcare options and treatment needed for your condition, no matter what the cost or whether it is covered under your plan.
- Work with your doctors and other healthcare professionals to make choices about your health care.
- Be treated with respect and dignity.
- Expect us to keep your personal health information private by following our privacy policies and state and Federal laws.
- Receive information you need to fully engage with your health plan and also share feedback. This includes:
- Our company and services.
- Our network of doctors and other healthcare professionals.
- Your rights and responsibilities.
- The way your health plan works.
- Make a complaint or file an appeal about:
- Your health plan and any care you receive.
- Any covered service or benefit decision that your health plan makes.
- Say no to care, for any condition, sickness, or disease without it having an effect on any care you may receive in the future. This includes asking your doctors and other healthcare professionals to tell you how that may affect your health now and in the future.
- Get the most up-to-date information from a doctor about the cause of your illness, your treatment, and what may result from it. You can ask for help if you do not understand this information.
You have the responsibility to:
- Read all information about your medical benefits under the Plan and ask for help if you have questions.
- Follow all medical Plan rules and policies.
- Choose a Network primary care physician, also called a PCP, if your health Plan requires it.
- Treat all healthcare professionals and staff with respect.
- Keep all scheduled appointments. Call your doctor’s office if you may be late or need to cancel.
- Understand your health challenges as well as you can and work with your doctors and other healthcare professionals to create an agreed upon treatment plan.
- Inform your doctors and other healthcare professionals if you don’t understand the type of care and your actions that they’re recommending.
- Follow the treatment plan that you have agreed upon with your doctors and other healthcare professionals.
- Share the information needed with us, your doctors, and other healthcare professionals to help you get the best possible care. This may include information about other health insurance benefits you have in addition to your coverage with us.
- Inform Member Services if you have any changes to your name, address, or family members covered under your Plan.
If you would like more information, have comments, or would like to contact us, please go to anthem.com and select Contact Us. Or call the Member Services number on your ID card.
We are here to provide high-quality benefits and service to our members. Benefits and coverage for services given under the Plan are overseen by your Certificate of Coverage, Member Handbook or Schedule of Benefits and not by this Member Rights and Responsibilities statement.
Effective Date: 5/2011; Revised 2/2013, 1/2015; Reviewed annually with last review 4/2022