Member Rights and Responsibilities

As a Member you have certain rights.

SilverSummit Healthplan wants to always respect your rights. We expect our providers to respect your rights.

Your rights are important to us:

▪ To be treated with respect, dignity and privacy

▪ To receive information about SilverSummit Healthplan, its services, its practitioners and providers and Member rights and responsibilities.

▪ To pick or change doctors from the provider network

▪ To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience orretaliation

▪ To be able to get in touch with your provider

▪ To go to any provider or clinic for family planning services

▪  To get care right away if you have a medical emergency

▪  To be told what your illness or medical condition is

▪  To discuss treatment options with your provider, what your provider thinks is best regardless ofcost or benefit of coverage.

▪  To work with your doctor to make decisions about your healthcare

▪  To give permission before the start of diagnosis, treatment or surgery▪  To refuse treatment

▪  To have your personal information in medical records kept private

▪  To request a copy of your medical record

▪  To request your medical record be amended or corrected as allowed by law

▪  To report any complaint, grievance or appeal about your provider or medical care

▪  To appeal action that reduces or denies services based on medical criteria

▪  To discuss treatment options with your providers and not be pressured into making decisionsabout treatment, regardless of cost or benefit of coverage.

▪  To not discriminate on the basis of race, color, national origin, age, sex, sexual orientation,gender identity, or disability.)

▪  To be treated in a cultural competent manner by the health plan and providers

▪  To request a second opinion

▪  To be notified at the time of enrollment and then also annually of your disenrollment rights

▪  To make an Advance Directive

▪  To file any complaint with Nevada DHCFP if your Advance Directive is not followed

▪  To choose a provider who gives you care whenever possible and appropriate

▪  To receive accessible healthcare services similar to services given under Medicaid FFS whichwould include similar amount, duration and scope.

▪  To get enough services to be reasonably expected to achieve the goal of the treatment

▪  To not have your services denied or reduced just because of a specific diagnosis, type ofillness or medical condition

▪  To use your rights without any negative effects from Nevada DHHS, SilverSummit Healthplan, itsproviders or contractors

▪  To receive all written Member information from SilverSummit Healthplan, at no cost to you and inlanguages other than English

▪  In other ways, to help with the special needs of Members who may have trouble reading theinformation for any reason

▪  To get interpretation services for free in any language

▪  To be told that interpretation services are available and how to get them

▪  To get help understanding the requirements and benefits of SilverSummit Healthplan from NevadaDHHS and its Enrollment Broker

▪  To receive a copy of Member rights and responsibilities and the right 

MEMBER RESPONSIBILITIES

Notify the Division of Welfare and Supportive Services (DWSS) if any of the following happens:

▪ Your family size changes

▪ You move out of the state or have other address changes

▪ You get or have health coverage under another policy, other third party or there are changesto that coverage

As a Member, you have certain responsibilities. Treatment can work better if you do these things:

▪ Provide SilverSummit Healthplan and your providers with correct and complete medical information theyneed in order to provide care.▪ Work on improving your own health

▪ Tell SilverSummit Healthplan when you go to the emergency room

▪ Talk to your provider about preauthorization of services they recommend

▪ Inform SilverSummit Healthplan if your Member ID card is lost or stolen

▪ Show your Member ID card and Nevada Medicaid ID card when getting healthcare services

▪ Know SilverSummit Healthplan procedures, coverage rules and restrictions the best that you can

▪ Contact SilverSummit Healthplan when you need information or have questions

▪ Give providers accurate and complete medical information▪ Follow prescribed treatment. Or tell your provider the reason(s) treatment cannot be followed as soon aspossible.

▪ Ask your provider questions to help you understand treatment. Learn about the possible risks, benefitsand costs of treatment alternatives. Make care decisions after you have thought about all of these things.

▪ Be actively involved in your treatment. Understand your health problems and be a part of makingtreatment goals with your provider as much as you can.

▪ Follow the grievance process if you have concerns about your care