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Medica Administrative Manual> Health Management and Quality Improvement > Member Rights and Responsibilities

Member Rights and Responsibilities

Medica recognizes the importance of a three-way relationship among members, their providers and their health plan. Medica believes that education about health care responsibilities is important because it helps members get the greatest benefit from their health plan. Therefore, Medica is sharing the following statements with Medica's physician and provider community in order to improve the health of the members Medica serves:

Unless otherwise noted, the term "member" as used throughout these statements refers to both fully insured members, and self-insured and Minnesota Health Care Programs enrollees.

Member Rights

Medica members have certain legal rights and responsibilities as identified below:

  1. Available and accessible services, including emergency services (defined in their "Certificate of Coverage") 24 hours a day, seven days a week.
  2. Information about their health condition, appropriate or medically necessary treatment options and risks, regardless of cost or benefit coverage, so the member can make an informed choice about their health care.
  3. Participate with providers in decision-making regarding their health care, including the right to refuse treatment recommended by Medica or any provider.
  4. A right to be treated with respect and recognition of their dignity and their right to privacy.
  5. Privacy of member's medical and financial records maintained by Medica or any network provider in accordance with existing law.
  6. Contact Medica and the applicable state regulator to file a complaint about issues related to benefits, (the "Certificate of Coverage" provides additional information). The member may begin a legal proceeding if they have a problem with Medica or any provider.
  7. Receive information about Medica, its services, its practitioners and providers, and members' rights and responsibilities.

Member Responsibilities

To increase the likelihood of maintaining good health and to ensure that the best quality care is received, it is important that the member take an active role in their health care by:

  1. Establishing a relationship with a network provider before becoming ill, as this allows for continuity of care;
  2. Providing the necessary information to health care professionals needed to determine the appropriate care. This objective is best obtained when the member does share:
    • Information about lifestyle practices; and
    • Personal and family health history;
  3. Following the instructions given by those providing health care.
  4. Practicing self-care by knowing:
    • How to recognize common health problems and what to do when they occur;
    • When and where to seek appropriate help; and
    • How to prevent health problems from recurring;
  5. Practicing preventive health care by:
    • Having the appropriate tests, exams and immunizations recommended for your gender and age as described in your "Certificate of Coverage"; and
    • Engaging in healthy lifestyle choices (such as exercise, proper diet and rest).

Additional Rights and Responsibilities

Medica has identified some additional rights and responsibilities for members, including the:

  1. Right to privacy.
  2. Right to file a complaint or an appeal about Medica, the care they received or a decision regarding their health care. Their coverage document has more information on their complaint and appeal rights.
  3. Right to make recommendations regarding Medica's members' rights and responsibilities statement.
  4. Responsibility to participate in understanding their health problems, participate in developing mutually agreed-upon treatment goals to the degree possible and to follow the plans that they have agreed on with their health care professional.

Nondiscrimination Policy

It is the policy of Medica to treat all persons alike, without distinctions based on race, color, creed, religion, national origin, gender, marital status, status with regard to public assistance, disability, sexual orientation, age or any other classification protected by law. If members have questions about this policy, please call Medica's Provider Service Center at 1-800-458-5512.


Confidentiality

Medica and any participating provider shall maintain the confidentiality of all information regarding members in accordance with all applicable state and federal statutes and regulations.

In addition, each participating provider shall maintain the confidentiality of all quality assessment, utilization review information, and the terms of any contractual arrangement, including the amounts reimbursed by Medica to the participating provider, and shall not disclose any such information to any third party or any division, business unit or affiliate and shall cause each participating provider to use his or her best efforts to protect such information from an unauthorized disclosure by any person and shall not use or allow any person to use any such information in any way that is detrimental to Medica or that may cause competitive disadvantage to Medica.

Notwithstanding the foregoing, Medica acknowledges the Hospital Price Transparency requirements from Centers for Medicare and Medicaid Services (CMS) effective January 1, 2021 and will not enforce any confidentiality of contract provision requirements against hospitals to the extent that such disclosure is required by CMS under these rules.


REV 11/2021

Date: 1/28/2023 6:04:32 PM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB01