RIGHTS & RESPONSIBILITIES

Member Rights

As a member of our health plan, you have the following rights:

  • To receive information about HAP CareSource™ MI Health Link (Medicare-Medicaid Plan), our services; our practitioners and providers; and member rights and responsibilities.
  • To receive all services that our plan must provide.
  • To be treated with dignity and respect.
  • To be afforded privacy and confidentiality in all aspects of care and for all health care information, unless otherwise required by law.
  • To be provided a copy of their medical records, upon request, and to request corrections or amendments to these records.
  • To have all plan options, rules and benefits fully explained, including through use of a qualified interpreter if needed.
  • To be given information about your health. This information may also be available to someone who you have legally approved to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
  • To receive a Health Risk Assessment upon enrollment in a plan.
  • Receive complete and accurate information of your health and functional status by the Integrated Care Team.
  • To have a voice in the governance and operation of the integrated system, provider or health plan.
  • To discuss information on any appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
  • To be able to take part in decisions about your health care unless it is not in your best interest.
  • To get information on any medical or behavioral health care treatment, given in a way that you can follow.
  • To be sure others cannot hear or see you when you are getting medical care.
  • To be free from any form of restraint or seclusion used as a means of force, discipline, ease or revenge as specified in federal regulations.
  • To ask for, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
  • To be able to say yes or no to having any information about you given out unless we have to by law.
  • To be able to say no to treatment or therapy. If you say no, the doctor or our plan must talk to you about what could happen and they must put a note in your medical record about it.
  • To be able to file an appeal, a grievance (complaint) or state hearing. You have a right to voice complaints or appeals about HAP CareSource MI Health LInk or care provided. See your member handbook for information.
  • To be able to get all HAP CareSource MI Health Link written member information from our plan:
    • At no cost to you.
    • In the prevalent non-English languages of members in HAP CareSource MI Health Link’s service area.
    • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.
  • To get information on all services and health care options, including available treatment options and alternatives, presented in a culturally appropriate manner, taking in consideration your condition and ability to understand. If you unable to participate fully in treatment decisions you have the right to designate a representative. This includes the right to have translation services available to make information appropriately accessible. Information must be available:
    • Before Enrollment
    • At Enrollment
  • Any time you need the information to make an informed choice
  • To involve caregivers or family members in treatment discussions and decisions.
  • Have advance directives explained and established for you if you so desire.
  • Get reasonable advance notice, in writing, of any transfer to another treatment setting and the justification for the transfer.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To exercise your right and that exercising those rights does not adversely affect the way the Integrated Care Organization (ICO) and its providers or the State Agency treat you.
  • To receive timely information about plan changes including orientation materials at least once per year. If there are any significant changes to these materials, you have the right to receive notice at least 30 calendar days prior to the intended effective date of the change.
  • To be protected from liability for payment of any fees that are the obligation of the ICO.
  • Not to be charged any cost sharing for any demonstration services.
  • To information on how to contact your Care Coordinator.
  • To be able to get help free of charge from our plan and its providers if you do not speak English or need help in understanding information.
  • To be able to get help with sign language if you are hearing impaired.
  • To be told if the health care provider is a student and to be able to refuse his/her care.
  • To be told of any experimental care and to be able to refuse to be part of the care.
  • To make advance directives (a living will).
  • To participate in all aspects of care, including the right to refuse treatment, and to exercise all rights of an appeal.
  • To file any complaint about not following your advance directive with the Michigan Department of Health and Human Services (MDHHS).
  • To be free to carry out your rights and know that HAP CareSource MI Health Link, HAP CareSource MI Health Link’s providers or the Michigan Department of Health and Human Services (MDHHS) will not hold this against you.
  • To know that we must follow all federal and state laws, and other laws about privacy that apply.
  • To have access to an adequate network of primary and specialty providers who are capable of meeting your needs with respect to physical access, and communication and scheduling needs, and are subject to ongoing assessment of clinical quality including required reporting.
  • To choose the provider that gives you care whenever possible and appropriate.
  • If you are a female, to be able to go to a woman’s health provider in our network for Medicaid-covered woman’s health services.
  • To be able to get a second opinion for Medicaid-covered services from a qualified provider in our network. If a qualified provider is not able to see you, we must set up a visit with a provider not in our network.
  • If HAP CareSource MI Health Link is unable to provide a necessary and covered service in our network, we will cover these services out of network for as long as we are unable to provide the service in network. If you are approved to go out of network, this is your right as a member and will be provided at no cost to you.
  • To get information about HAP CareSource MI Health Link from us.
  • To make recommendations regarding HAP CareSource MI Health Link’s member rights and responsibility policy.
  • To make recommendations regarding a change in HAP CareSource MI Health Link staff.
  • To choose a plan and provider at any time, including a plan outside of the demonstration. You have the choice for the effective date to be the first calendar day of the following month when your application is received before the last five calendar days of the month. Applications received during the last five calendar days of the month will result in enrollments with an effective date the first calendar day of the next month after the following month. For example, an application received on March 28 will only be effective May 1.
  • To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Michigan Department of Health and Human Services (MDHHS) with any complaint of discrimination based on race, ethnicity, national origin, religion, sex, age, sexual orientation, medical or claims history, mental or physical disability, genetic information or source of payment.

Member Responsibilities

As a member of HAP CareSource MI Health Link you must also be sure to:

  • Have an in-network primary care provider (PCP).
  • Keep scheduled doctor (specialist) appointments, be on time, and if you have to cancel, call 24 hours in advance.
  • Follow the plans and instructions for care you have agreed upon with your doctors and other health care providers.
  • Always carry your HAP CareSource MI Health Link member ID card and present it when receiving services.
  • Never let anyone else use your HAP CareSource MI Health Link member ID card.
  • Notify your county caseworker and HAP CareSource MI Health Link of a change in your phone number or address.
  • Contact your primary care provider (PCP) after going to an urgent care center or after getting medical care outside of HAP CareSource MI Health Link’s covered counties or service area.
  • Let HAP CareSource MI Health Link and your county caseworker know if any member of your family has other health insurance coverage.
  • MIDHHS - MI Health Link LogoProvide the information that HAP CareSource MI Health Link and your health care providers need in order to provide care for you.
  • Understand as much as possible about your health conditions and take part in reaching goals that you and your PCP agree upon.
  • Let us know if you suspect health care fraud or abuse.