The GEMCare member has the right to:
- Be treated with respect and dignity.
- Receive considerate and respectful care with full consideration of the member's privacy.
- Receive confidential treatment of all information and records associated with the member's care.
- Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service.
- Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the member, in order to give informed consent or to refuse the course of treatment.
- Actively participate in decisions regarding the member's health care and treatment plan. To the extent permitted by law, this includes the right to refuse any procedure or treatment. If the recommended procedure or treatment is refused, an explanation will be given addressing the effect that this will have on the member's health.
- Be informed of continuing health care requirements following office visits, treatments, procedures and hospitalizations.
- Be informed of the name and qualifications of the physician who has primary responsibilities for coordinating the member's care; and be informed of the names, qualification and specialties of other physicians and non-physicians who are involved in the member's care.
- Change primary care physicians by contacting the GEMCare Customer Services Department.
- Have 24-hour access to the member's primary care physician (or covering physician).
- Be provided with information about GEMCare, its services and the health care service delivery process.
- Be informed of non-emergent cost of care and receive an explanation of the member's financial obligations as appropriate, prior to incurring the expense (including co-payments, deductibles and co-insurance).
- Examine and receive an explanation of bills generated for services delivered to the member.
- Be informed of applicable rules in the various health care settings regarding member conduct.
- Have all member rights apply to the person who has the legal responsibility to make health care decisions for the member.
- Express opinions or concerns about GEMCare or the care provided and offer recommendations for change in the health care service delivery process by contacting the GEMCare Customer Services Department.
- Be informed of the member complaint/grievance and appeal process.
- Exercise these rights without regard to gender, sexual orientation or cultural, economic, educational or religious background.
The GEMCare member has the responsibility to:
- Be on time for all appointments and notify the provider's office as far in advance as possible for appointment cancellation or rescheduling.
Provide the health care provider with complete and accurate information which is necessary for the care of the member (to the extent possible).
- Inform providers of the member's inability to understand the information given to him/her.
- Carry out the treatment plan which has been developed and agreed upon by the health care provider and the member.
- Contact the primary care physician (or covering physician) for any care which is needed after that physician's normal office hours.
- Report changes in his/her condition according to provider instructions.
Treat the health care providers and staff with respect.
- Respect the rights, property and environment of all physicians and GEMCare providers, staff and other members.
- Be familiar with the benefits and exclusions of his/her health plan coverage.
- Contact GEMCare's Customer Services Department or the Health Plan Member Services Department regarding questions and assistance.
- Be familiar and comply with GEMCare's health care service delivery system regarding access to routine, urgent and emergent care.
- Obtain an authorized referral from the primary care physician as required for a visit to a specialist and/or to receive any specialty care.
- Have all of these responsibilities apply to the person who has the legal responsibility to make health care decisions for the member.
- Pay the appropriate copayment at the time of service.
- Pay for all non-covered services.