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Member Resources

Rights and Responsibilities

As a Jefferson Health Plans member, we want to make sure you understand your rights and responsibilities. Continue reading to learn more about what you can expect from us.

Your Member Rights

Here are your rights as a Jefferson Health Plans member:

  • We must provide information in a way that works for you, such as in languages other than English, in Braille, in large print, or other alternate formats.
  • We must treat you with fairness and respect at all times.
  • We must ensure that you get timely access to your covered services and drugs.
  • We must protect the privacy of your personal health information.
  • We must give you information about the plan, its network of providers, and your covered services. This includes:
    • Information about your coverage and the rules you must follow when using your coverage.
    • Information about why something is not covered and what you can do about it.
  • We must support your right to make decisions about your care. This includes:
    • Having the right to know your treatment options and participate in decisions about your health care.
    • Having the right to give instructions about what is to be done if you are not able to make medical decisions for yourself.
  • You have the right to make complaints and to ask us to reconsider decisions we have made.

If you believe your rights aren’t being respected and you feel you have been discriminated against, you can call the U.S. Department of Health and Human Services Office of Civil Rights at 1-800-368-1019 or TTY 1-800-537-7697 or call your local Office for Civil Rights.

If you believe you have been treated unfairly or your rights have not been respected, and it's not about discrimination, you can get help dealing with the problem you are having:

  • You can call Member Relations at 1-866-901-8000 (TTY 1-877-454-8477).
  • You can call the State Health Insurance Assistance Program, Apprise, at 1-800-783-7067.
  • You can call Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048.

Your Member Responsibilities

You also have some responsibilities as a member of the plan. You are responsible for:

  • Becoming familiar with your covered services and the rules you must follow to get these covered services.
  • Telling us if you have any other health insurance coverage or prescription drug coverage in addition to our plan.
  • Telling your doctor and other health care providers that you are enrolled in our plan.
  • Helping your doctors and other providers care for you by giving them information, asking questions, and following through on instructions.
  • Being considerate of your providers and respecting the rights of other patients.
  • Paying what you owe for your Medicare coverage and the services you receive.
  • Giving us your new contact information if you move.