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Introduction about your rights and protections
Your right to be treated with fairness and respect
Your right to the privacy of your medical records and personal health information
Your right to see participating providers and nonparticipating providers and
get covered services
Your right to know your treatment choices and participate in decisions
about your health care
Your right to use advance directives (such as a living will or a power of
attorney)
Your right to make complaints
Your right to get information about your health care coverage and costs
Your right to get information about the UPREHS Medicare Secondary Plan, and participating providers
How to get more information about your rights
What can you do if you think you have been treated unfairly or your rights are not being respected?
What are your responsibilities as a member of the UPREHS Medicare Plans?
Introduction about your rights and protections
Since you have Original Medicare and membership in the UPREHS Medicare Plans, you have certain
rights to help protect you. In the first part of this section, we explain Medicare rights and protections as a
member of UPREHS. Then, after we have explained your rights, we tell you what you can do if you think
you are being treated unfairly or your rights are not being respected. If you want to receive Medicare
publications on your rights, you may call and request them from Medicare at 1-800-MEDICARE (1-800-
633-4227; TTY 1-877-486-2048). You can call 24 hours a day, 7 days a week.
Your right to be treated with fairness and respect
You have the right to be treated with dignity, respect, and fairness at all times. Health care providers and
UPREHS must obey laws against discrimination that protect you from unfair treatment. These laws say that
you cannot be discriminated against (treated unfairly) because of your race, color, age, religion, national
origin, or any mental or physical disability you may have. If you need help with communication, such as help
from a language interpreter, please call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-
2048). Customer Services can also help you if you need to file a complaint about access (such as wheel chair
access). You can also call the Office for Civil Rights at 1-800-368-1019 or TTY/TDD 1-800-537-7697, or,
call the Office for Civil Rights in your area.
Your right to the privacy of your medical records and personal health information
There are Federal and State laws that protect the privacy of your medical records and personal health
information. We keep your personal health information private as protected under these laws. Any
personal information that you give us when you enroll in this plan is protected. We will make sure that
unauthorized people do not see or change your records. Generally, we must get written permission from
you (or from someone you have given legal power to make decisions for you) before we can give your
health information to anyone who is not providing your care or paying for your care. There are a few
exceptions allowed or required by law, such as release of health information to government agencies that
are checking on quality of care.
The laws that protect your privacy give you rights related to getting information and controlling how
your health information is used. We are required to provide you with a notice that tells about these rights
and explains how we protect the privacy of your health information that is in our possession as an
insurer. UPREHS is usually not in possession of your medical records; the provider keeps them.
UPREHS usually only has your claims information. You have the right to know how your health
information has been given out and used for non-routine purposes. The same laws protect privacy of
your medical records information that is in the possession of your providers. For example, you have the
right to look at your medical records and to get a copy of the records (the provider may charge you a fee
for making copies). You also have the right to ask providers to make additions or corrections to your
medical records. If you have questions or concerns about privacy of your personal and claims
information in possession of UPREHS, please call UPREHS Customer Services at 1-800-547-0421.
Your right to see participating providers and nonparticipating providers and
get covered services
As explained in this Benefit Guide, you have a choice as to whether or not you see participating
providers, that is, doctors and other health providers who are part of the UPREHS participating network.
You have the right to choose a UPREHS participating provider and to see specialists when care from a
specialist is needed. You do not need a referral to see a specialist. Section 2 explains how to use
participating providers to get the care and services you need. Section 3 explains your rights to get care
for a medical emergency and urgently needed care. Your UPREHS Prime Medicare Plan 2011 Benefit
Guide explains your rights under the Medicare Part D prescription drug plan.
Your right to know your treatment choices and participate in decisions about your health care
You have the right to get full information from your providers when you go for medical care, and the
right to participate fully in decisions about your health care. Your providers must explain things in a way
that you can understand. Your rights include knowing about all of the treatment choices that are
recommended for your condition, no matter what they cost or whether Medicare or the UPREHS
Medicare Plans covers them. You have the right to be told about any risks involved in your care. You
must be told in advance if any proposed medical care or treatment is part of a research experiment, and
be given the choice of refusing experimental treatments.
You have the right to receive a detailed explanation from the doctor if you believe that a participating
provider has denied care that you believe you are entitled to receive or care you believe you should
continue to receive. In these cases, you must request an initial decision. Initial decisions are discussed
in Sections 10 and 11.
You have the right to refuse treatment. This includes the right to leave a hospital or other medical facility,
even if your doctor advises you not to leave. This includes the right to stop taking your medication. If you
refuse treatment, you accept responsibility for what happens as a result of refusing treatment.
Your right to use advance directives (such as a living will or a power of attorney)
You have the right to ask someone such as a family member or friend to help you with decisions about
your health care. Sometimes, people become unable to make health care decisions for themselves due to
accidents or serious illness. If you want to, you can use a special form to give someone you trust the legal
authority to make decisions for you if you ever become unable to make decisions for yourself. You also
have the right to give your doctors written instructions about how you want them to handle your medical
care if you become unable to make decisions for yourself. The legal documents that you can use to give
your directions in advance in these situations are called advance directives. There are different types of
advance directives and different names for them. Documents called living will and power of attorney for
health care are examples of advance directives.
If you decide that you want to have an advance directive, there are several ways to get this type of legal
form. You can get a form from your lawyer, from a social worker, and from some office supply stores.
You can sometimes get advance directive forms from organizations that give people information about
Medicare, such as a State Health Insurance Assistance Program (SHIP). Section 1 of this booklet tells
how to contact a SHIP. Regardless of where you get this form, keep in mind that it is a legal document.
You should consider having a lawyer help you prepare it. It is important to sign this form and keep a copy at home. You should give a copy of the form to your doctor and to the person you name on the
form as the one to make decisions for you if you can’t. You may want to give copies to close friends or
family members as well.
If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive,
take a copy with you to the hospital. If you are admitted to the hospital, they will ask you whether you
have signed an advance directive form and whether you have it with you. If you have not signed an
advance directive form, the hospital has forms available and will ask if you want to sign one.
Remember, it’s your choice whether you want to fill out an advance directive (including whether you
want to sign one if you are in the hospital). According to law, no one can deny you care or discriminate
against you based on whether or not you have signed an advance directive. If you have signed an
advance directive, and you believe that a doctor or hospital has not followed the instructions in it, you
may file a complaint with your State Department of Health.
Your right to make complaints
You have the right to make a complaint if you have concerns or problems related to your coverage or
care. Appeals and grievances are the two different types of complaints you can make. Which one you
make depends on your situation. Appeals and grievances are discussed in Section 10 and 11.
If you make a complaint, we must not treat you unfairly (discriminate against you) because you made a complaint.
Your right to get information about your health care coverage and costs
This booklet tells you what medical services are covered for you under Original Medicare and the UPREHS
HCPP and MSP and what you have to pay. If you need more information, please call Medicare at 1-800-
MEDICARE (1-800-633-4227) or UPREHS Customer Services at 1-800-547-0421. You have the right to
an explanation from us about any bills you may get for services not covered by the UPREHS HCPP and
MSP. We must tell you in writing why we will not pay for a service, and how you can file an appeal to ask
us to change this decision. (See Section 10 and 11 for more information about filing an appeal.)
Your right to get information about the UPREHS Medicare Secondary Plan, and participating providers
You have the right to get information from us about the UPREHS Medicare Secondary Plan. This
includes information about our financial condition and about UPREHS participating health providers.
Your Medicare Summary Notice (MSN) and UPREHS Explanation of Benefits tell you exactly how
payment was made for your benefits. The Medicare program does not allow us to pay doctors in a way
that would keep them from giving you the care you need. To get any of this information, call UPREHS
Customer Services at 1-800-547-0421.
How to get more information about your rights
If you have questions or concerns about your rights and protections, please call Customer Services at 1-
800-547-0421. You can get free help and information from your State Health Insurance Assistance
Program, or SHIP. In addition, the Medicare program has written a booklet called Your Medicare Rights
and Protection. To get a free copy, call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-
486-2048). Or you can visit the Medicare Website at www.medicare.gov to order this booklet or print it
directly from your computer. You can call 24 hours a day, 7 days a week.
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What can you do if you think you have been treated unfairly or your rights are not being respected?
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If you think you have been treated unfairly or your rights have not been respected, what you
should do depends on your situation.
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If you think you have been treated unfairly due to your race, color, national origin, disability,
age, or religion, please tell Medicare at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-
2048), or UPREHS Customer Services at 1-800-547-0421. Or, you can call the Office for Civil
Rights in your area.
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For any other kind of concern or problem related to your Medicare rights and protections
described in this section, you can call Medicare at 1-800-MEDICARE (1-800-633-4227; TTY
1-877-486-2048), or UPREHS Customer Services at 1-800-547-0421. You can also get help
from your State Health Insurance Assistance Program, or SHIP.
What are your responsibilities as a member of the UPREHS Medicare Plans?
Along with the rights you have as a member of UPREHS, you also have some responsibilities. Your
responsibilities include the following:
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To become familiar with your coverage and the rules you must follow to get care as a member.
You can use this booklet to learn about your coverage, what you have to pay, and the rules you
need to follow. Please call UPREHS Customer Services at 1-800-547-0421 if you have any
questions.
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To pay your UPREHS plan premiums. You must also meet your other financial responsibilities
that are described in Section 8.
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To give your doctor and other providers the information they need to care for you, and to follow
the treatment plans and instructions that you and your doctors agree upon. Be sure to ask your
doctors and other providers if you have any questions and to explain your treatment in a way you
can understand.
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To act in a way that supports the care given to other patients and helps the smooth running of
UPREHS, your doctor’s office, hospitals, and other offices.
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To let us know if you have any questions, concerns, problems, or suggestions. If you do, please
call UPREHS Customer Services at 1-800-547-0421.
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UPREHS. Plan for Life.™ 
