Member Rights and Responsibilities

Member Rights

As a valued member of NHP, you have the right to:

• Receive information about NHP, our services, our providers and practitioners, your covered benefits, and your rights and responsibilities as a Member of NHP.
• Receive documents in alternative formats and/or oral interpretation services free of charge for any materials in any language.
• Have your questions and concerns answered completely and courteously.
• Be treated with respect and with consideration for your dignity.
• Have privacy during treatment and expect confidentiality of all records and communications.
• Discuss and receive information regarding your treatment options, regardless of cost or benefit coverage, with your Provider in a way which is understood by you. You may be responsible for payment of services not included in the Covered Services list for your coverage type.
• Be included in all decisions about your health care, including the right to refuse treatment and the right to receive a Second Opinion on a medical procedure at no cost to you.
• Change your Primary Care Provider.
• Access Emergency care twenty-four (24) hours a day, seven (7) days a week.
• Access an easy process to voice your concerns, and expect follow-up by NHP.
• File a Grievance or Appeal or if you have had an unsatisfactory experience with NHP or with any of our contracted Providers, or if you disagree with certain decisions made by NHP.
• Make recommendations regarding NHP's Member rights and responsibilities.
• Create and apply an Advance Directive, such as a will or a health care proxy, if you are over 18 years of age.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
• Freely apply your rights without negatively affecting the way NHP and/or your Provider treats you.
• Ask for and receive a copy of your health record and request that it be changed or corrected, as explained in the Notice of Privacy Practices on page 59 of the Member Handbook.
• Receive the Covered Services you are eligible for as outlined in the Covered Services list enclosed with the Member Handbook.

Member Responsibilities

As a Member of NHP, you also have responsibilities. It is your responsibility to:

• Choose a Primary Care Provider, the Provider responsible for your care.
• Call your Primary Care Provider when you need health care.
• Tell any health care Provider that you are an NHP Member.
• Give complete and accurate health information that NHP or your Provider needs in order to provide care.
• Understand the role of your Primary Care Provider in providing your care and arranging other health care services that you may need.
• To the degree possible, understand your health problems and take part in making decisions about your health care and in developing treatment goals with your Provider.
• Follow the plans and instructions agreed to by you and your Provider.
• Understand your benefits and know what is covered and what is not covered.
• Call your Primary Care Provider within forty-eight (48) hours of any Emergency or Out-of-Network treatment. If you experienced a Behavioral Health Emergency you should contact your Behavioral Health Provider, if you have one.
• Notify NHP of any changes in personal information such as address, telephone, marriage, additions to the family, eligibility of other health insurance coverage, etc.
• Understand that you may be responsible for payment of services you receive that are not included in the Covered Services list for your coverage type.