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Members

Member Rights and Responsibilities

Doctor and patient talking

Member Rights

  • Members have the right to be treated with respect and recognition of their dignity by everyone who works with Molina Healthcare.
  • Members have the right to get information about Molina Healthcare, our providers, our doctors, our services and member's rights and responsibilities.
  • Members have the right to choose their "main" doctor from Molina Healthcare's network. (This doctor is called a primary care doctor or personal doctor.)
  • Members have the right to be informed about their health. If members have an illness, they 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. Molina Healthcare keeps their medical records private.*
  • Members have the right to see their medical record, including the results of their Initial Health Assessment (IHA). Members also have the right to get a copy of and or correct their medical record where legally okay.*
  • Members have the right to complain about Molina Healthcare or their care. Members can call, fax, email or write to Molina Healthcare's Member Services.
  • Members have the right to appeal Molina Healthcare's decisions. Members have the right to have someone speak for them during their grievance.
  • Members have the right to ask for a State Fair Hearing by calling toll-free (801) 538-6576. Members also have the right to get information on how to get an expedited State Fair Hearing quickly.
  • Members have the right to dis enroll from Molina Healthcare (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 someone outside Molina Healthcare to look into therapies that are experimental or being done as part of exploration.
  • 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 get interpreter services on a 24-hour basis, at no cost, to help them talk with their doctor or us if they prefer to speak a language other than English.
  • Members have the right to not be asked to bring minor, friend, or family member with them to act as their interpreter.
  • Members have the right to get information about Molina Healthcare, their providers, or their health in the language they prefer.
  • Members also have the right to ask for and get materials in other formats such as larger size print, audio, and Braille upon request and in a timely fashion appropriate for the format being requested and in accordance with state laws.
  • Members have the right to receive instructions on how they can view online, or request a copy of Molina Healthcare's non-proprietary clinical and administrative policies and procedures.
  • Members have the right to get a copy of Molina Healthcare's list of approved drugs (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 Molina Healthcare's contracted hospitals.
  • Members have the right to access family planning services, Federally Qualified Health Centers, Indian Health Facilities, sexually transmitted disease services, and Emergency services, outside of Molina Healthcare’s network according to federal laws. You do not need to get Molina Healthcare’s approval first.
  • Members have the right to get minor consent services.
  • Members have the right not to be treated poorly by Molina Healthcare, their doctors or the Department of Health Care Services for acting on any of these rights.
  • 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.

*Subject to State and Federal laws.

Member Responsibilities

  • Members have the responsibility to learn and ask about their health benefits. If members have a question about their benefits, call toll-free (888) 483-0760.
  • Members have the responsibility to give information to their doctor, provider, or Molina Healthcare 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 built and keep a strong patient-doctor relationship. Members have the responsibility to cooperate with their doctor and staff, keep appointments, and be on time. If members are going to be late or cannot keep their appointment, they should call their doctor’s office
  • Members have the responsibility to give their Molina Healthcare and State card when getting medical care. Members have the responsibility to not give their card to others and let Molina Healthcare or the State know about any fraud or wrongdoing.
  • Members have a responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals as they are able.

*You may request printed copies of all content posted on our website.

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This information is for Doctors and
Health Care Professionals only.

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