Member Rights and Responsibilities

YOUR RIGHTS AS A MEMBER

As a Member of SilverSummit Healthplan, you have rights. These rights help make sure you are treated fairly and with respect. We want you and your doctor to follow these rights. We expect our providers to respect your rights.

You have the right:

To be treated with respect and privacy
To learn about SilverSummit Healthplan and the care you can get
To choose or change your doctor
To be free from being held down or kept alone as punishment
To contact your doctor when you need to
To go to any clinic for family planning
To get emergency care right away
To be told what your illness or condition is
To talk with your doctor about all treatment options, even if they cost more
To help make decisions about your care
To say yes or no before tests, treatments, or surgery
To say no to treatment▪ To keep your medical records private
To ask for a copy of your medical records
To ask for changes to your medical records if needed
To report a complaint or appeal about your care
Report any critical incident that might hurt you or make you sick (tell someone if something happens thatcould hurt you or make you sick)
To tell someone right away if something happens that could hurt your health or safety
To appeal if care is denied or reduced
To get help with transportation to appeal hearings
To talk about treatment without being pressured
To be treated fairly no matter your race, color, age, gender, disability, or background
To be treated in a way that respects your culture
To ask for a second opinion\To be told about your right to leave the health plan
To make an Advance Directive (a plan for your care if you can’t speak for yourself)
To file a complaint if your Advance Directive is not followed
To choose a provider when possible
To get care that is like what Medicaid offers
To get enough care to help you reach your health goals
To not be denied care just because of your illness or condition
To use your rights without being treated unfairly
To get written information in your language and at no cost
To get help if you have trouble reading or understanding information
To get free interpreter services in any language
To be told how to get interpreter services
To get help understanding your health plan from Nevada DHHS
To get a copy of your rights and responsibilities and share ideas to improve them

YOUR RESPONSIBILITIES AS A MEMBER

You also have responsibilities. These help you get the best care possible.

Tell the Division of Social Services (DSS) if:

Your family size changes
You move or change your address
You get other health insurance or your coverage changes

As a Member, you should:

Give correct and complete medical information to your doctor and SilverSummit
Try to improve your health
Tell SilverSummit if you go to the emergency room
Talk to your doctor about getting approval for services
Tell SilverSummit if your Member ID card is lost or stolen
Show your Member ID card when you get care
Learn about your health plan rules and coverage
Contact SilverSummit if you have questions
Follow your treatment plan or tell your doctor why you can’t
Ask questions to understand your care
Learn about the risks, benefits, and costs of treatments
Help make decisions about your care
Be involved in your treatment and work with your doctor to set health goals
Use the grievance process if you have concerns about your care