Member Rights & Responsibilities

As a SummaCare member, you have the following rights and responsibilities. Please read them carefully. These statements help ensure that you are treated by SummaCare employees and all of our contracted providers with fairness and respect. Likewise, it is important that you understand your responsibilities as a SummaCare member. If you don’t follow these responsibilities, you may not receive all of the services or coverage to which you might otherwise be entitled. Please call Customer Service if you ever feel you’ve been denied any of these rights or if you have any questions.

As a SummaCare member, you have the right to:

1. Receive timely and accurate information about SummaCare including its services, its practitioners and providers and its members’ rights and responsibilities
2. Be treated with fairness, respect and dignity;
3. Be assured your medical records and personal health information will be handled confidentially and your privacy protected. Please refer to SummaCare’s Notice of Privacy Practices (NOPP) for a complete description of your privacy rights;
4. Participate with your healthcare professional in making decisions about your healthcare;
5. A candid discussion of appropriate or medically/surgically necessary treatment options for your conditions, regardless of cost or benefit coverage;
6. Voice complaints or appeals about SummaCare or the care provided;
7. Provide advance directives that would inform your doctor of your wishes should you have a terminal illness or lose your ability to make decisions for yourself;
8. A safe, secure, clean and accessible medical environment;
9. Get information about your coverage and costs as a member of SummaCare that is easy to understand;
10. Obtain information about SummaCare and our contracted provider’s financial arrangements and qualifications;
11. See plan providers, get covered services and get your prescriptions filled within a reasonable period of time;
12. Make recommendations regarding SummaCare’s “Members’ Rights and Responsibilities” statement.

As a SummaCare member, you have the responsibility to:

1. Provide (to the extent possible) information that SummaCare and its healthcare professionals need in order to care for you;
2. Understand (to the degree possible) your health problems and participate in developing and following mutually agreed upon treatment goals;
3. Follow the guidelines and instructions for care that you have agreed on with your healthcare professional;
4. Keep medical appointments. If you cannot keep an appointment, you should notify the healthcare professional’s office;
5. Identify yourself via your membership card, to use the card appropriately and to assure that other people do not use your card;
6. Respect SummaCare employees and your healthcare professional and refrain from using threatening or abusive language or mannerisms;
7. Act in a way that supports the care given to other patients and helps the smooth running of your doctor’s office, hospitals and other offices;
8. Familiarize yourself with your coverage and the rules you must follow to get care as a SummaCare member;
9. Pay in full any plan premiums, copayments, coinsurance amounts or deductibles required by your specific SummaCare benefit plan;
10. Call SummaCare Customer Service if you have any questions, suggestions or problems with your care or payment.

How to get more information about your rights and responsibilities:

If you have questions or concerns about your rights and protections or if you think you have been treated unfairly or your rights have not been respected, you should call SummaCare Customer Service at the number listed on your SummaCare ID card. We will ensure that your issue is addressed and give you additional information on the complaint and appeal processes available to you. If you have been treated unfairly due to your race, color, national origin, disability, age or religion, please let SummaCare know. You can also call the Office for Civil Rights in your area.