Member Rights and Responsibilities

As a HIP member, you share a special relationship with us and with our participating providers. For HIP, that means being committed to protecting your rights to confidentiality, clear information, timely responses and care that meets or exceeds clinical standards. Similarly, you have a responsibility to keep us informed, follow treatment plans and comply with all provisions of your HIP coverage.

Together, we can assure that you receive the full advantages of your HIP membership.

Your rights as a HIP member

• The right to understand your rights. If for any reason you do not understand these rights or how to interpret them, HIP and its participating physicians will provide you with assistance.

• The right to treatment without discrimination as to race, color, religion, gender, national origin, disability, sexual orientation or source of payment.

• The right to a non-smoking environment.

• The right to receive considerate and respectful care in a clean and safe environment.

• The right to be provided, upon request, with a list of the participating physicians serving you and the times that such physicians are normally available for appointments, with the understanding that these are subject to change.

• The right to refuse to participate in, or be a patient for, research. In deciding whether to participate, you have the right to a full explanation.

• The right to change physicians, in accordance with the provisions of your policy.

• The right to be assured that medical services will be provided only by persons having the qualifications set forth in the Professional Standards established by HIP’s Credentialing Committee, whose Professional Standards shall be made available upon request.

• The right to know the names, positions and functions of any participating provider’s staff and refuse their treatment, examination or observation.

• The right to obtain from your physician, at reasonable times, comprehensive information about your diagnosis, treatment and prognosis in terms you can reasonably be expected to understand. When it is not medically advisable to give such information to you, or when the member is a minor or incompetent, the information shall be made available to an appropriate person on the member’s behalf.

• The right to receive from your physician information necessary to allow you to give informed consent prior to the start of any procedure or treatment.

• The right to refuse treatment, to the extent permitted by law, and to be informed of the medical consequences of such an action.

• The right to have all lab reports, x-rays, specialists’ reports and other medical records completed and placed in your chart as promptly as practicable so as to make them available, if possible, to your physician at the time of consultation.

• The right to be informed as to all medication given to you, as well as the reasons for prescribing the medication and its expected effects.

• The right to receive all information you need to give informed consent for an order not to resuscitate. You also have the right to designate an individual to give this consent if you are too ill to do so.

• The right to request a medical consultation with a second specialist from any HIP participating physician.

• The right to every consideration of privacy concerning your medical care program that shall mean, among other things, that no person not directly involved in your care may be present without your permission during any portion of your discussion, consultation, examination or treatment.

• The right to expect that all communications, records and other information pertaining to your care or personal condition will be kept confidential, except if disclosure is required by law or permitted by you.

• The right to request that unaltered copies of your complete medical records be forwarded to a physician or hospital of your choice, the cost of duplicating and forwarding to be paid by you.

• The right, upon written request, to have made available to you copies of your medical records. Reasonable fees (in accordance with the applicable law) may be charged for such copies. Information may be withheld from you, however, if in the reasonable exercise of a physician’s judgment it is believed that the release of such information would adversely affect your health. Additionally, a parent or guardian may be properly denied access to medical records or information relating to a minor’s pregnancy, abortion, birth control or sexually transmitted diseases if the minor’s consent is not obtained.

• The right to have a person of your choice accompany you in any meeting or discussion with medical or administrative personnel.

• The right to consult by appointment, at reasonable times, with responsible administrative officials at HIP and your participating physician’s office to make specific recommendations for the improvement of the delivery of health services.

• The right to file a grievance, appeal or external review relative to a determination about care and services rendered. For additional information on filing a grievance, review the section on If You Disagree with a Decision or Service in the Member Handbook and/or call HIP’s Customer Service Department at 1-800-HIP-TALK (1-800-447-8255).

IMPORTANT: State and federal laws give adults in New York State the right to accept or refuse medical treatment, including life-sustaining treatment, in the event of catastrophic illness or injury. As your health insurer, it is HIP’s duty to make you aware of your rights in these matters. Included with your membership kit are materials on advance directives with written instructions such as a living will or health care proxy containing your wishes relating to health care should you become incapacitated. Please read this material carefully.

Your responsibilities as a HIP member:

• The responsibility to provide HIP and its participating physicians and other providers with accurate and relevant information about your medical history and health so that appropriate treatment and care can be rendered.

• The responsibility to keep pre-scheduled appointments or to cancel appointments, giving as much notice as possible.

• The responsibility to update your record with accurate personal data including changes in name, address, phone number, additional health insurance carriers, and increases and/or decreases in dependents within 30 days of the event.

• The responsibility to treat with consideration and courtesy all persons associated with HIP or any hospital or health facility to which you are referred.

• The responsibility to be actively involved in your own health care by seeking and obtaining information, by discussing treatment options with your physician and by making informed decisions about your health care.

• The responsibility to follow through with treatment plans agreed upon by all partners in your health care: you, HIP and participating physicians.

• The responsibility to understand HIP’s benefits, policies and procedures and to utilize the HIP system as outlined in your Contract or Certificate of Coverage and Handbook, including appropriate authorization for use of out-of-network services for a medical condition that is not life threatening.

• The responsibility to pay copayments, if applicable, at the time services are rendered.

• The responsibility to abide by the policies and procedures of your participating physician’s office.