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Member Rights and Responsibilities

Below are the Molina Healthcare rights and responsibilities as written in the Molina Healthcare Member Handbook. State law requires that health care providers or health care facilities recognize Member rights while they are receiving medical care and that Members respect the health care providers.

MEMBER RIGHTS

To choose: Members have the right to select a Primary Care Provider (PCP) for themselves and each covered member of their family from Molina Healthcare's network of providers.

To obtain information: Members have the right to receive information about their rights and responsibilities as a member of Molina Healthcare. Members have the right to obtain information about services that are covered, services that are not covered and any costs that they may be responsible for paying. Members have the right to receive a listing of Molina Healthcare participating practitioners in order to choose a Primary Care Physician. Members have the right to receive preventive care information and information about their illnesses and treatment options. Members have the right to obtain information about how to file a complaint, appeal, or grievance. Members have the right to ask for information about Advance Directives.

To be heard: Members have the right to make recommendations regarding the Molina Healthcare's Member Rights and Responsibility policy. Members have the right to comment about quality improvement at Molina Healthcare.

To have privacy and confidentiality: Members have the right to privacy and confidentiality in communications and records about their care.

To receive medical care: Members have the right to receive medical treatment that is available when they need it. Members have the right to receive emergency medical treatment twenty four hours a day/seven days a week.

To participate in their care: Members have the right to make decisions about their care. Members have the right to have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage. Members have the right to obtain information about the risks and benefits of treatment. Members have the right to receive this information in terms they understand.

To refuse medical care: Members have the right to refuse medical care. We urge Members to discuss their concerns about care with their provider. Practitioners or providers may give a Member advice, but the Member has the final decision.

To present a complaint, appeal, or grievance: Members have the right to voice concerns about Molina Healthcare, its providers or the quality of care they receive. Members have the right to receive a prompt and fair review of their concerns without being discriminated against.

To be represented by an Advocate: Members have the right to have Molina Healthcare's Member Advocate help them to resolve problems and guide them through the grievance process if they do not agree with a decision Molina Healthcare made. Members have the right to appear in person and present their case in a grievance hearing or to have Molina Healthcare's Member Advocate represent their side at the hearing.

To be treated with respect and dignity: Members have the right to be treated with respect and dignity regardless of their race, age, gender, sexual orientation, or creed.

To be free from physical restraints: Members have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in Federal regulations on the use of restraints and seclusion.

To be treated in a culturally competent way: Members have the right to be treated in a manner that respects their beliefs and cultural values.

MEMBER RESPONSIBILITIES

To choose a personal provider: Members have a responsibility to choose a personal provider from among Molina Healthcare's network of PCPs and to establish a relationship with that provider. Members have a responsibility to call Molina Healthcare if they want to change their PCP.

To know their benefits and requirements: Members have a responsibility to read and understand their health plan benefits and limitations, and to follow required procedures. Members also have a responsibility to know how to use Molina Healthcare's provider network and to ask questions when they do not understand.

To provide accurate information: Members have a responsibility to provide honest, accurate and complete information about their health history, their eligibility, and their enrollment. Members have a responsibility to show their Molina Healthcare ID card each time they receive services. Members have a responsibility to let their provider know if they have other insurance coverage.

To participate in their care: Members have a responsibility to participate in their care by asking questions about their health. Members also have a responsibility to follow the plans and instructions for care that they have agreed upon with their Providers and to make healthy lifestyle choices to maintain their health or manage their illness. Members have a responsibility to know the medicines they take and why and how to take those medicines.

To keep their appointments: Members have a responsibility to keep their appointments and be on time or to call their provider's office ahead of time if they are going to be late or miss an appointment. Members have a responsibility to understand that missing appointments without letting the provider know may cause the provider to refuse to see them.

To show consideration and respect: Members have a responsibility to show consideration and respect to health plan staff and health care providers.

To report changes: Members have a responsibility to notify their local county/tribal social or human service agency of any enrollment status changes such as family size or address. Members have a responsibility to notify Molina Healthcare with any changes to their address or phone number.

To use Molina Healthcare providers: Members have a responsibility to use Molina Healthcare participating providers and health care facilities unless they have our approval to go somewhere else or it is a life threatening emergency.

*Printed copies of information posted on our website are available upon request.​​

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