MEMBER RIGHTS AND RESPONSIBILITIES

• To get accurate, easy-to-understand information to help you make good choices about your child’s health plan, services, doctors, hospitals and other providers.
• To get accurate, easy-to-understand information to help you make good choices about your child’s health plan, services, doctors, hospitals and other providers.
• Your health plan must tell you if they use a “limited provider network.”  This is a group of doctors and other providers who only refer patients to other doctors who are in the same group.  Meaning, you cannot see all the doctors who are in your health plan.  If your health plan uses “limited networks,” you should check to see that your child’s primary care provider and any specialist doctor you might like to see are part of the same “limited network.”
• You have a right to know how your doctors are paid.  Some get a fixed payment no matter how often you visit.  Others get paid based on the services they give to your child.  You have a right to know about what those payments are and how they work.
• You have a right to know how the health plan decides about whether a service is covered and/or medically necessary.  You have the right to know about the people in the health plan who decide those things.
• You have a right to know the names of the hospitals and other providers in your health plan and their addresses.
• You have a right to pick from a list of health care providers that is large enough so that your child can get the right kind of care when your child needs it.
• If your child is confirmed to have special health care needs or a disability, you may be able to use a specialist as your child’s primary care provider.  Ask your health plan about this.
• Children who are confirmed to have special health care needs or a disability have the right to special care.
• If your child has special medical problems, and the doctor your child is seeing leaves your health plan, your child may be able to continue seeing that doctor for three months, and the health plan must continue paying for those services.  Ask your plan about how this works.
• Your daughter has the right to see a participating obstetrician/gynecologist (OB/GYN) without a referral from her primary care provider and without first checking with your health plan.  As you plan how this works.  Some plans may make you pick an OB/GYN before seeing that doctor without a referral.
• You have a right to emergency services when your child needs them if you reasonably believe your child’s life is in danger, or that your child would be seriously hurt without getting treated right away.  Coverage of emergencies is available without first checking with your health plan.  You may have to pay a co-payment in the CHIP Program, depending on your income.
• You have the right and responsibility to take part in all the choices about your child’s health care.
• You have the right to speak for your child in all treatment choices.  You have the right to talk to your doctors about the necessary clinical or medical treatment options for your child’s conditions, regardless of cost of covered benefit.
• You have the right to get a second opinion from another doctor in your health plan about what kind of treatment your child needs.
• You have the right to be treated fairly and with respect and recognition by your health plan, doctors, hospitals and other providers.
• You have the right to talk to your child’s doctors and other providers in private, and to have your child’s medical records kept private.  You have the right to look over and copy your child’s medical records and to ask for changes to those records. 
• You have the right to voice complaints in order to solve problems with your health plan and the plan’s doctors, hospitals and others who provide services to your child.  If your health plan says it will not pay for a covered service or benefit that your child’s doctor thinks is medically necessary, you have the right to have another group, outside the health plan, tell you if they think your doctor or the health plan was right.  This is called an appeal.
• You have the right to get information and to make suggestions about your rights and responsibilities

MEMBER RESPONSIBILITIES

• Try to follow health habits.  Encourage your child to stay away from tobacco and to eat a healthy diet.
• Supply the information that your doctors and providers and the plan need in order to provide care for your child.
• Become involved in the doctor’s decisions about your child’s treatments.  Follow the plans and instructions for care that you have agreed on with your child’s doctors
• Work together with your health plan’s doctors and other providers to understand health care problems and pick treatment goals for your child that you have all agreed upon.
• If you have a disagreement with you health plan, try first to resolve it using the health plan’s complaint process.
• Learn about what your health plan does and does not cover.  Read your Member Handbook to understand how the rules work.
• If you make an appointment for your child, try to get to the doctor’s office on time.  If you cannot keep the appointment, be sure to call and cancel it.
• If your child is in the CHIP program, you are responsible for paying your doctor and other providers’ co-payments that you owe them
• Report misuse of the CHIP Program by health care providers, other members, or health plans.

CHIP Perinatal (Unborn Child) Program Rights and Responsibilities

• To get accurate, easy-to-understand information to help you make good choices about your unborn child’s health plan, services, doctors, hospitals and other providers.
• You have a right to know how the perinatal doctors are paid.  Some get a fixed payment no matter how often you visit.  Others get paid based on the services they provide for your unborn child.  You have a right to know about what those payments are and how they work.
• You have a right to know how the health plan decides about whether a perinatal service is covered and/or medically necessary.  You have the right to know about the people in the health plan who decide those things.
• You have a right to know the names of the hospitals and other Perinatal providers in your health plan and their addresses.
• You have a right to pick from a list of health care providers that is large enough so that your unborn child can get the right kind of care when it is needed.
• You have the right to emergency Perinatal services when your unborn child needs them if you reasonably believe your unborn child’s life is in danger, or that your unborn child would be seriously hurt without getting treated right away.  Coverage of such emergencies is available without first checking with your health plan.
• You have the right and responsibility to take part in all the choices about your unborn child’s health care.
• You have the right to speak for your unborn child in all treatment choices. 
• You have the right to be treated fairly by the health plan, doctors, hospitals and other providers.
• You have the right to talk to your Perinatal provider in private, and to have your medical records kept private.  You have the right to look over and copy your  medical records and to ask for changes to those records. 
• You have the right to a fair and quick process for solving problems with the health plan and the plan’s doctors, hospitals and others who provide Perinatal services for your unborn child.  If the health plan says it will not pay for a covered Perinatal service  or benefit that your unborn child’s doctor thinks is medically necessary, you have a right to have another group, outside the health plan, tell you if they think your doctor or health plan was right.

• Try to follow health habits.  Stay away from tobacco and to eat a healthy diet.
• Become involved in the doctor’s decisions about your unborn child’s care. 
• If you have a disagreement with the health plan, try first to resolve it using the health plan’s complaint process.
• Learn about what your health plan does and does not cover.  Read your CHIP Perinatal Program Handbook to understand how the rules work.
• Try to get to the doctor’s office on time.  If you cannot keep the appointment, be sure to call and cancel it.
• Report misuse of the CHIP Perinatal Program by health care providers, other members, or health plans.