Member Rights and Responsibilities
As a Seaside Health Plan member, you have the right to...
Respectful and courteous treatment. You have the right to be treated with respect, dignity and courtesy from your health plan’s providers and staff. You have the right to be free from retaliation or force of any kind when making decisions about your care.
Privacy and confidentiality. You have the right to have a private relationship with your provider and to have your medical record kept confidential. You also have the right to receive a copy of, amend, and request corrections to your medical record. If you are a minor, you have the right to certain services that do not need your parents' okay.
Choice and involvement in your care. You have the right to receive information about your health plan, its services, its doctors and other providers. You have the right to choose your primary care provider (PCP) from the doctors and clinics listed in your health plan’s provider directory. You also have the right to get appointments within a reasonable amount of time. You have the right to talk with your doctor about any care your doctor provides or recommends, discuss all treatment options, and participate in making decisions about your care. You have the right to a second opinion. You have the right to talk candidly to your doctor about appropriate or medically necessary treatment options for your condition, regardless of the cost or what your benefits are. You have the right to information about treatment regardless of the cost or what your benefits are. You have the right to decline treatment. You have a right to decide in advance how you want to be cared for in case you get a life- threatening illness or injury.
Receive timely customer service. You have the right to wait no more than 10 minutes to speak to a customer service representative during Seaside Health Plan's normal business hours.
Voice your concerns. You have the right to complain about Seaside Health Plan, the providers we work with, and the care you get without fear of losing your benefits. Seaside Health Plan will help you with the process. If you don’t agree with a decision, you have the right to appeal, which is to ask for a review of the decision.
Service outside of your health plan’s provider network. You have the right to receive emergency or urgent services as well as family planning and sexually transmitted disease services outside of your health plan’s network. You have the right to receive emergency treatment whenever and wherever you need it.
Service and information in your language. You have the right to request an interpreter at no charge instead of using a family member or friend to interpret for you. You should not use children to interpret for you. You have the right to get the Member Handbook and other information in another language or format (such as audio, large print or Braille).
Know your rights. You have the right to receive information about your rights and responsibilities. You have the right to make recommendations about these rights and responsibilities.
As a Seaside Health Plan member, you have the responsibility to...
Act courteously and respectfully. You are responsible for treating your doctor and all providers and staff with courtesy and respect. You are responsible for being on time for your visits or calling your doctor’s office at least 24 hours before your visit to cancel or reschedule.
Give up-to-date, accurate and complete information. You are responsible for giving correct information and as much information as you can to all of your providers and to Seaside Health Plan. You are responsible for getting regular checkups and telling your doctor about health problems before they become serious.
Follow your doctor’s advice and take part in your care. You are responsible for talking over your health care needs with your doctor, developing and agreeing on goals, doing your best to understand your health problems, and following the treatment plans and instructions you both agree on.
Use the Emergency Room only in an emergency. You are responsible for using the emergency room in cases of an emergency or as directed by your doctor.
Report wrong-doing. You are responsible for reporting health care fraud or wrongdoing to Seaside Health Plan. You can do this without giving your name by calling the 24-Hour Ethics Hotline at (888)933-9044 and leaving a message or sending an e-mail to email@example.com.