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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 get your prescriptions filled within a reasonable period of time
Your right to know your treatment choices and participate in decisions about your health care
Your right to make complaints
Your right to get information about your drug coverage and costs
Your right to get information about our Plan and our network pharmacies
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 our Plan?
Introduction about your rights and protections
Since you have Medicare, you have certain rights to help protect you. In this first part of Section 8, we explain your Medicare rights and protections as a member of our Plan. We will tell you what you can do if you think you are being treated unfairly or your rights are not being respected. If you want Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 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. We must obey laws against discrimination that protect you from unfair treatment. These laws say that we cannot discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin, or any mental or physical disability you may have.
If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. You can also reach 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 health information that you give us when you enroll in our 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 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. For example, you have the right to look at your medical records, and to get a copy of the records (there may be a fee charged for making copies). UPREHS does not have your medical records – your healthcare provider keeps them. You also have the right to ask your healthcare provider to make additions or corrections to your medical records (if you ask them to do this, they will review your request and determine whether the changes are appropriate). You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about the privacy of your personal information and medical records, please call our Customer Services 1-800-547-0421.
NOTE: As a member of UPREHS, your personal information, including prescription drug event data will be released to Medicare, who may release it to researchers pursuant to all applicable privacy laws for research purposes.
Your right to get your prescriptions filled within a reasonable period of time
As explained in this Benefit Guide, you should get all of your prescriptions filled from the preferred UPREHS Depot Drug Mail Order Pharmacy, a UPREHS Depot Drug Walk-In Pharmacy, or Ascend Specialty Drug Pharmacy. You have the right to timely access to your prescriptions. Timely access means that you can get your prescriptions filled within a reasonable amount of time. Section 1 explains how to use the preferred UPREHS Depot Drug Mail Order Pharmacy, the UPREHS Depot Drug Walk-In Pharmacies, the Ascend Specialty Drug Pharmacy, or a nonpreferred network pharmacy to get a temporary prescription filled.
Your right to know your treatment choices and participate in decisions about your health care
You have the right to know about the different Medication Therapy Management Programs we offer and in which you may participate if you meet certain criteria. You have the right to be told about any risks involved in your care. You have the right to refuse treatment. 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.
You have the right to get a detailed explanation from us if you believe that a pharmacy has denied coverage for a Medicare Part D drug that you believe you are entitled to get or care you believe you should continue to get. In these cases, you must request an initial decision. Initial decisions are discussed in Section 6.
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 6. If you make a complaint, we must treat you fairly (not discriminate against you).
Your right to get information about your drug coverage and costs
This Benefit Guide tells you what you have to pay for prescription drugs as a member of our Plan. If you need more information, please call our Customer Services at 1-800-547-0421. You have the right to an explanation from us about any bills you may get for drugs that are covered by Medicare Part D and/or our Plan. We must tell you why we will not pay for a Medicare Part D drug, and how you can file an appeal to ask us to change this decision. See Section 6 for more information about filing an appeal.
Your right to get information about our Plan and our preferred and nonpreferred network pharmacies
You have the right to get information from us about UPREHS and the UPREHS Prime Medicare Plan. This includes information about our financial condition and about our preferred and nonpreferred network pharmacies. To get any of this information, call 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 our Customer Services at 1-800-547-0421. You can also get free help and information from your State Health Insurance Assistance Program, or SHIP. The Introduction section tells how to contact the SHIP in your State. The Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, you can visit www.medicare.gov to order this booklet or print it directly from your computer.
What can you do if you think you have been treated unfairly or your rights are not being respected?
For concerns or problems related to your Medicare rights and protections described in this section, you can call our Customer Services at 1-800-547-0421. You can also get help from your State Health Insurance Assistance Program, or SHIP. The Introduction section tells how to contact the SHIP in your State.
What are your responsibilities as a member of our Plan?
Along with the rights you have as a member of our Plan, you also have some responsibilities. Your responsibilities include the following:
- Become familiar with your coverage and the rules you must follow to get care as a member. You can use this Benefit Guide and other information we give you, such as your Formulary, Benefit Summary and other communications we send to you to learn about your coverage, what you have to pay, and the rules you need to follow. Please call Customer Services at 1-800-547-0421 if you have any questions.
- Give your health care provider(s) the information they need to care for you, and follow the treatment plans and instructions given to you. Be sure to ask your health care provider(s) if you have any questions.
- Pay your Plan premiums and any copayments you may owe for the covered drugs you get. You must also meet your other financial responsibilities that are described in Section 3.
- Let us know if you have any questions, concerns, problems, or suggestions. If you do, please call our Customer Services at 1-800-547-0421.
| Last Updated: 04/17/2008 |
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UPREHS. Plan for Life.™ 
