Member Rights & Responsibilities

woman in wheelchair

Your Member Rights and Responsibilities

Did you know that as a member of Passport, you have certain rights and responsibilities? Knowing your rights and responsibilities will help you, your family, your provider and Passport ensure that you get the covered services and care that you need. You have the right to:

Your Membership Rights

  • Respect, dignity, privacy, confidentiality, accessibility and nondiscrimination

  • Get information on the structure and operation of the health plan, its services, its practitioners and providers and member rights and responsibilities

  • To receive notice of any significant changes in the Benefits Package at least thirty (30) days before the intended effective date of the change

  • Prepare Advance Medical Directives

  • Timely referral and access to medically indicated specialty care

  • Be furnished health care services in accordance with federal and state regulations

  • Choose your Primary Care Provider and to change your PCP in a reasonable manner

  • Consent for or refusal of treatment and active participation in decision choices

  • Voice Grievances and receive access to the Grievance process, receive assistance in filing an appeal, and request a State Fair Hearing from the Contractor and/or the Department

  • Know if a co-payment or contribution is required. Know the names, education, and experience of your health care providers

  • Be treated with respect with recognition of your dignity and your right to privacy

  • Timely access to care that does not have any communication or physical access barriers

  • Timely referral and access to medically indicated specialty care

  • Receive Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services

  • Take part in decision making with your doctor about your health care, including the right to refuse treatment and openly discuss appropriate or medically necessary treatment choices of your health problems, regardless of cost or coverage. Get a fair and timely reply to requests for service. Voice complaints or appeals about the organization and the care it provides

  • Know that your member information will be kept private. It is only used in reports to the state to show that the Plan is following state rules and laws

  • Ask how your doctor is paid

  • To be able to file an appeal, a grievance (complaint) or request a State Fair Hearing (after Passport has made a decision and you aren’t happy with that decision)

  • To get help with filing an appeal, grievance (complaint) or request a State Fair Hearing (after Passport has made a decision and you aren’t happy with that decision)

  • To receive information  and timeframes for filing an appeal, a grievance or a State Fair Hearing

  • To make recommendations  regarding the Plan’s member rights and responsibility policy

  • To use any hospital or other setting for emergency care

  • To receive detailed information  on emergency and after-hours coverage

  • To receive all information, including but not limited to, enrollment notices, informational materials, instructional materials, available treatment options, and alternatives in a manner and format that may be easily understood

  • Be free from any form of restraint or seclusion used as means of pressure, discipline, convenience or retaliation

  • Include assistance with requesting and receiving a copy of your medical records at no cost to you, and request that they be corrected

  • Be provided culturally and linguistically appropriate healthcare services (CLAS) Be provided covered healthcare services

  • Be free to exercise your rights without negatively affecting the way Passport, our providers or the State treat you.

  • Be free from other discrimination prohibited by State and Federal regulations

  • Request clinical practice guidelines upon request

  • Get a second medical opinion

  • Get help with any special language needs

  • To receive interpretation by phone services free of charge for all non-English languages, not just those identified as prevalent

  • Prepare Advance Medical Directives

  • Be furnished health care services in accordance with federal and state regulations

  • Passport members have the responsibility to work with their PCP to protect and improve your health.  You can report other insurance benefits, when you are eligible, to your Department for Medicaid Services Specialist by calling Beneficiary Help Line at (800) 642-3195, TTY (866) 501-5656

  • Show your Passport ID card, Medicaid card and valid ID to all providers before receiving services

  • Never let anyone use your Passport ID card or Medicaid card

  • Make appointments for routine checkups and immunizations (shots)

  • Keep your scheduled appointments and be on time calling as soon as you can if you must cancel

  • Provide complete information about your past medical history

  • Provide complete information about current medical problems

  • Listen to your PCP’s advice and ask questions about your care when you are in doubt

  • Call or go back to your PCP if you do not get better or ask to see another provider

  • Follow your provider’s medical advice

  • Respect the rights of other patients and healthcare workers

  • Use emergency room services only when you believe an injury or illness could result in death or lasting injury

  • Notify your primary provider if emergency treatment was necessary and follow-up  care is needed

  • Report changes that may affect your coverage to your Department for Medicaid Services specialist. This could be an address change, birth of a child, death, marriage or divorce, or change in income

  • Promptly apply for Medicare or other insurance when you are eligible

  • Find out how your health coverage works

  • Call your PCP when you need medical care, even if it is after-hours

  • Tell us if you have problems with any health care staff by calling Member Services at (800) 578-0603, 7 a.m.- 7p.m., Monday through Friday



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