Every member has the right to:

1. Receive dignified, respectful, courteous, and considerate treatment by all staff;

2. Receive information and communications in a language that he/she understands, to include information about Monarch HealthCare, its services, its practitioners and providers, and member rights and responsibilities;

3. Make recommendations to Monarch HealthCare regarding its members’ rights and responsibilities policies;

4. Receive preventative health services;

5. Be informed of all health services available to them;

6. Know and understand his/her medical problem and treatment plan;

7. Receive a response to a request for service, including evaluations and referrals, within 30 days. Urgent conditions shall receive a response within 24 hours;

8. Question his/her medical treatment and participate in decisions regarding the treatment plan;

9. Obtain a second opinion;

10. Be fully informed of all processes and procedures, including appeals and grievances, with his/her health network;

11. Have the confidentiality of his/her medical records protected;

12. Have a medical complaint/grievance referred directly to his/her health network Quality Management Department, in order to protect the information in his/her medical record;

13. Be represented by parents, guardians, family members or other conservators, should the member be unable to make treatment decisions himself/herself.

Every member shall have the responsibility to:

1. Learn about his/her medical condition and what keeps him/her healthy;

2. Actively participate in the health care programs that keep him/her well;

3. Inform his/her PCP of his/her medical condition;

4. Follow the treatment plan prescribed by his/her PCP;

5. Make and keep appointments for check-ups when he/she is sick, and inform the PCP’s office when an appointment must be cancelled.

6. Be cooperative and courteous to the people who are partners in his/her health care; and

7. Carefully review, understand, and follow the guidelines in the Evidence of Coverage (EOC)/member booklet provided to the member.

 

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