Medicare : Member Rights

 

Our plan must honor your rights as a member of the plan. You have the following rights to help protect you:

 

• We must provide information in a way that works for you (in languages other than English, in Braille, or other alternative formats, etc.)
• We must treat you with fairness, respect and dignity at all times
• We must ensure that you get timely access to your covered services and drugs
• We must protect the privacy of your personal health information 
• We must give you information about the plan, its network of providers, your covered services, and your rights and responsibilities
• We must support your right to make decisions about your care 
• You have the right to make complaints and to ask us to reconsider decisions we have made
• You have the right to make recommendations as well as get more information about your rights and responsibilities

 

You also have certain Rights and Responsibilities upon disenrollment. If you disenroll, remember the following during the disenrollment process:

 

• Until your membership ends, you are still a member of our plan.
• You should continue to use our network pharmacies to get your prescriptions filled until your membership in our plan ends.
• If you are hospitalized on the day that your membership ends, you will usually be covered by our plan until you are discharged (even if you are discharged after your new health coverage begins).
• If you leave Ohana, you can join another Medicare Advantage plan as long as this type of plan is available in your area, they are accepting new members, and you meet the eligibility requirements of the plan.
• You may only disenroll or switch plans during specific time periods each year.
• We cannot ask you to leave our plan for any reason related to your health.

 

Ohana must end your membership in the plan if any of the following happen:

 

• If you do not stay continuously enrolled in Medicare Part A and Part B. 
• If you move out of the service area.
  • If you move or take a long trip, you need to call Customer Service to find out if the place you are moving or traveling to is in our plan's area.
• If you become incarcerated (go to prison).
• If you lie or withhold information about other insurance you have that provides prescription drug coverage
• If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan.
• If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan.
  • We cannot make you leave our plan for this reason unless we get permission from Medicare first.
• If you let someone else use your membership card to get medical care.
  • If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General.

 

Member Responsibilities

Along with the rights you have as a member of our Plan, you also have some responsibilities: 

 

• Get familiar with your covered services and the rules you must follow to get these covered services.
• If you have any other health insurance coverage or prescription drug coverage besides our plan, you are required to tell us.
• Tell your doctor and other health care providers that you are enrolled in our plan.
• Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
• Be considerate.
• Pay what you owe.
• Tell us if you move.
• Call Customer Service for help if you have questions or concerns.

 

Please review our Evidence of Coverage for more detailed information on all Member Rights and Responsibilities including disenrollment situations and procedures.

Last modified: 10/21/2011