Member Rights

• Members have the right to be treated with respect and recognition of their dignity by everyone who works with MHC.
• Members have the right to receive information about MHC, our providers, our doctors, our services and member's rights and responsibilities.
• Members have the right to choose their primary care physician (PCP) from MHC's network.
• Members have the right to be informed about their health. If members are ill, members have the right to be told about treatment options regardless of cost or benefit coverage. Members have the right to have all questions about their health answered.
• Members have the right to help make decisions about their health care. Members have the right to refuse medical treatment.
• Members have the right to privacy. MHC keeps their medical records private in accordance with State and Federal laws.
• Members have the right to see their medical record, including the results of their Initial Health Assessment (IHA). Members also have the right to ask for corrections to their medical record and receive a copy of it in compliance with State and Federal requirements.
• Members have the right to complain about MHC or their care by calling, faxing, e-mailing or writing to MHC's Member Services Department.
• Members have the right to appeal MHC's decisions. Members have the right to have someone speak for them during the grievance.
• Members have the right to disenroll from MHC (Leave the Molina Healthcare Health Plan.).
• Members have the right to ask for a second opinion about their health condition.
• Members have the right to ask for an external independent review of experimental or investigational therapies.
• Members have the right to decide in advance how they want to be cared for in case they have a life-threatening illness or injury.
• Members have the right to receive interpreter services on a 24 hour basis, at no cost, to help them talk with their doctor or MHC if they prefer to speak a language other than English.
• Members have the right to not be asked to bring a friend or family member with them to act as their interpreter.
• Members have the right to receive information about MHC, their providers, or their health in their preferred language.
• Members also have the right to request and receive materials in other formats such as larger print, audio, and Braille. Members have the right to request information in printed form translated into their preferred language.
• Members have the right to receive a copy of MHC's drug formulary on request.
• Members have the right to submit a grievance if they did not get medically needed medications after an emergency visit at one of MHC's contracted hospitals.
• Members have the right to access minor consent services.
• Members have the freedom to exercise these rights without negatively affecting how they are treated by MHC, its providers or the Department of Health Care Services.
• Members have a right to make recommendations regarding the organization's member rights and responsibilities policies.
• Members have the right to be free from controls or isolation used to pressure, punish or seek revenge.
• Members have the right to file a grievance or complaint if they believe their linguistic needs were not met by the plan.
• Medi-Cal Members also have the right to request a State Fair Hearing by calling 800-952-5253. Members also have the right to receive information on the reason for which an expedited State Fair Hearing is possible.
• Medi-Cal Members also have the right to receive family planning services, treatment for any sexually transmitted disease, emergency care services, from Federally Qualified Health Centers and/or Indian Health Services without receiving prior approval and authorization from MHC.

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Member Responsibilities

• Members have the responsibility to be familiar with, and ask questions about, their health benefits. If Members have a question about their benefits, they may call MHC's Member Services Department at 888-665-4621.
• Members have the responsibility to provide information to their doctor or MHC that is needed to care for them.
• Members have the responsibility to be active in decisions about their health care.
• Members have the responsibility to follow the care plans and instructions for care that they have agreed on with their doctor(s).
• Members have the responsibility to build and keep a strong patient-doctor relationship.
• Members have the responsibility to cooperate with their doctor and staff. This includes being on time for their visits or calling their doctor if they need to cancel or reschedule an appointment.
• Members have the responsibility to present their MHC and State card when receiving medical care and report any fraud or wrongdoing to MHC or the proper authorities.
• Members have a responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
• Healthy Families Members also have a responsibility to keep current in their premium payment to the Healthy Families Administrator. Be aware of services requiring co-payment. Maintain a record of the co-payments made during the calendar year.
• Healthy Families Members also have a responsibility to inform the Member Services Department of any change of address or any changes to entitlement that could affect continuing eligibility.
• AIM members also have a responsibility to inform the Member Services Department of any change of address or any changes to entitlement that could affect continuing eligibility.

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