Member Rights & Privacy

Capital Health Plan Member's Rights and Responsibilities

For a complete, definitive description of your rights and responsibilities as a member of CHP, please refer to your Member Handbook* or the master policy or contract provided to your employer.

You Have a Right To:

• Receive information about CHP, the services, benefits, member rights and responsibilities, and participating practitioners who provide care.

• Receive medical care and treatment from practitioners and providers who have met the credentialing standards of CHP.

• Expect CHP participating practitioners to permit you to participate in decision-making about your health care consistent with legal, ethical, and relevant patient-practitioner relationship requirements. If you are unable to fully participate in treatment decisions you have a right to be represented by your parents, guardians, family members, health care surrogates or other conservators to the extent permitted by applicable laws.

• Expect health care practitioners who participate with CHP to provide treatment with courtesy, respect, and with recognition of your dignity and right to privacy.

• Communicate complaints or appeals about CHP or the care provided through the established appeal or grievance procedures found in your Member Handbook and the master policy or contract provided to your employer.

• Have candid discussion with practitioners about the best treatment options for you no matter what the cost of the treatment or your benefit coverage.

• Refuse treatment if you are willing to accept the responsibility and consequences of that decision.

• Have access to your medical records, request amendments to your records, and have confidentiality of these records and member information protected and maintained in accordance with State and Federal law and CHP policies.

• Make recommendations regarding CHP's member rights and responsibilities policies.

• Call or write us anytime with helpful comments, questions and observations, whether concerning something you like about our plan, or something you feel is a problem area. Expect to receive a timely response from CHP staff.

You Have a Responsibility To:

• Seek all non-emergency care through your primary care physician (PCP), obtain a referral from your PCP for medical services by a specialist when required, and cooperate with those providing care and treatment.

• Be courteous; respect the rights, needs and privacy of other patients, office staff and providers of care.

• Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care for you.

• Understand your health problems and participate in developing mutually agreed upon treatment goals to the degree possible.

• Follow the plans and instructions for care that you have agreed to with your practitioners.

• Ask questions and seek clarification to enable you to participate fully in your care.

• Pay copayments and provide current information concerning your CHP membership status to any CHP participating practitioner or provider.

• Follow established procedures for filing a complaint, appeal or grievance concerning medical or administrative decisions that you feel are in error.

• Review and understand the benefit structure, both covered benefits and exclusions, as outlined in the Member Handbook*. Cooperate and provide information that may be required to administer benefits.

• Seek access to medical and member information through your Primary Care Physician, CHPConnect or through CHP Member Services.

• Follow the coverage access rules in your Member Handbook*.

*Note: Capital Health Plan's Member Handbook is intended to highlight the Plan and does not constitute a contract. The precise benefits will be controlled by the master policy or contract.

January, 2012

Privacy of Medical Information

All CHP member health information is confidential. Disclosures (such as employers) for purposes other than treatment, payment, or health care operations are made only when CHP receives a member's Authorization for Release of Health Information form.

To Our Members:

Capital Health Plan knows that the way we conduct our business offers us the opportunity to earn our customer's respect and trust. Our customers are our reason for being. To that end, we believe our customers have the right to privacy and that their non-public personal, financial and health information should be kept confidential.

Our practices to protect your privacy are not new. However, new laws now require we notify you about our privacy policy concerning

• What kind of personal information we collect about you and how we obtain it
• How we use your personal information
• What kind of personal information about you we release to other companies
• How we protect your personal information

This Privacy Notice is provided to help you better understand how we protect your non-public personal, financial and health information.

If you have questions about our privacy policy, please feel free to contact us. If you are one of our members you can call Member Services at 383-3311. If you are an employer representative you can reach us through a Sales Representative.

What Kind Of Personal Information Do We Collect And How Do We Obtain It?

Generally, the information includes your name, address, phone number, social security number, date of birth, age, sex, height and weight, occupation, health habits, general medical information. It could also include accident and injury dates. Most of this information is provided by you.

We obtain personal information about you from the following source

• Information you provided us, or an affiliate, on an application form for health plan coverage;
• Information your physician or other health care practitioner provided us;
• Information your employer provides us;
• Information received from other sources

How Do We Use Your Personal Information?

We use your personal information to perform transactions and functions necessary to implement and administer the health plan benefits purchased from us. On occasion, your personal information is used for reporting or other functions required or permitted by law. What Kind Of Personal Information About You Do We Release? We may share any of the information we collect about you (as described above) with our affiliates, namely our health business partners. We may disclose any of the information we collect about you to other parties, including vendors retained to audit medical records and billings. However, the type and the amount of information we share with others is limited to what is necessary to implement and administer the health plan you have with us, or as otherwise permitted or required by law. We may disclose any of the information we collect about you (as described above) to companies that perform marketing or other services on our behalf, including administrative services.

How Do We Protect Your Information?

We maintain physical, electronic, and procedural safeguards to protect your personal information. We access and use your personal information to the extent necessary to administer the health plan services you are entitled to. We establish confidentiality agreements with contracted parties that receive non-public personal financial and health information about you. We restrict access to your non-public personal, financial and health information to those employees who need to know that information to administer the product or service you purchased from us.