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Member Rights and Responsibilities

Provider Type

  • Physicians
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

Members have the right to expect a certain level of service from their health care providers. Members are also responsible for cooperating with providers in obtaining health care services. Health Net developed member rights and responsibilities statements in accordance with the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid Services (CMS). These member rights and responsibilities apply to member's relationships with Health Net, and all participating providers responsible for member care. In addition to member rights and responsibilities, medical services must be provided in a culturally competent manner without regard to race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, age, health status, physical or mental handicap, or disability.

Health Net members are notified annually of their rights and responsibilities via the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI). The actual statements of member rights and responsibilities may vary slightly from what is listed below. Health Net members with questions regarding their rights and responsibilities should be directed to their specific member materials.

Members have the right to:

  • Receive information about the organization, its services, its providers and member rights and responsibilities
  • Be treated with respect and recognition of their dignity and right to privacy
  • Participate with providers in making decisions about their health care
  • A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
  • Voice complaints or appeals about the organization or the care it provides
  • Make recommendations regarding the organization's member rights and responsibilities policies
  • Request translation of written vital document materials into threshold languages or verbal translation into the member's preferred language

Receive 24-hour access to interpreter services, free of cost to members, and without reasonable delay at all medical points of contact

Members have the responsibility to:

  • Supply information (to the extent possible) that the organization and its providers need in order to provide care
  • Follow plans and instructions for care that they have agreed on with their providers
  •  

Understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible 

Last Updated: 10/30/2019