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Member Rights and Responsibilities

FamilyCare Health Member Rights

Find information about appeals and grievances

Our plan must honor your rights as a member of the plan. 

  • We must provide information in a way that works for you and in your preferred language.
  • We must treat you with fairness and respect at all times.
  • We must ensure that you get timely access to your covered services and drugs.
  • We must protect the privacy of your personal health information.
  • We must give you information about the plan, its network of providers, and your covered services, including:

            Information about our plan. 

            Information about our network providers including our network pharmacies.

            Information about your coverage and the rules you must follow when using your coverage.

            Information about why something is not covered and what you can do about it.

  • We must support your right to make decisions about your care. You have the right to know your treatment options and participate in decisions about your health care. You have the right:

            To know about all of your choices. 

            To know about the risks. 

            To say “no.” 

            To receive an explanation if you are denied coverage for care. 

  • You have the right to give instructions about what is to be done if you are not able to make medical decisions for yourself.
  • You have the right to make complaints and to ask us to reconsider decisions we have made.

What can you do if you believe you are being treated unfairly or your rights are not being respected?

  • If it is about discrimination, call the Office for Civil Rights at 800-368-1019.
  • If it is about something else:

              You can call FamilyCare Health Navigation Services at 1-866-798-2273.

              Calls to this number are free.

              Hours are:

              October 1–February 14: Seven days a week, 8 a.m.–8 p.m

              February 15–September 30: Monday–Friday, 8 a.m.–8 p.m., and Saturdays and Sundays, 9 a.m.–5 p.m.

              Member Services also has free language interpreter services available for non-English speakers.

  • You can call the State Health Insurance Assistance Program at 800-722-4134.
  • Or, you can call Medicare at 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users should call 877-486-2048.

How to get more information about your rights:

  • You can call FamilyCare Health Navigation Services at 1-866-798-2273. Calls to this number are free.

           Hours are:

           October 1–February 14: Seven days a week, 8 a.m.–8 p.m

           February 15–September 30: Monday–Friday, 8 a.m.–8 p.m., and Saturdays and Sundays, 9 a.m.–5 p.m.

           Member Services also has free language interpreter services available for non-English speakers.

  • You can call the State Health Insurance Assistance Program at 800-722-4134.
  • You can contact Medicare.

            You can visit the Medicare website to read or download the publication “Your Medicare Rights & Protections.” (The publication is available at: www.medicare.gov/Pubs/pdf/11534.pdf.) 

-- OR --

            You can call 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY/TDD users should call 877-486-2048.

For more detailed information on your rights as a member of our plan, please read your Evidence of Coverage chapter entitled “Your rights and responsibilities.”

FamilyCare Health Member Responsibilities

  • Get familiar with your covered services and the rules you must follow to get these covered services. 
  • If you have any other health insurance coverage or prescription drug coverage in addition to our plan, you are required to tell us. 
  • Tell your doctor and other healthcare providers that you are enrolled in our plan.
  • Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
  • Be considerate. 
  • Pay what you owe. 
  • Tell us if you move. 
  • If you move outside of our plan service area, you cannot remain a member of our plan. 
  • If you move within our service area, we still need to know. 
  • Call Navigation Services for help if you have questions or concerns. 

          You can call Navigation Services at 1-866-798-2273. Calls to this number are free.

          Hours are:

          October 1–February 14: Seven days a week, 8 a.m.–8 p.m

          February 15–September 30: Monday–Friday, 8 a.m.–8 p.m., and Saturdays and Sundays, 9 a.m.–5 p.m.

          Member Services also has free language interpreter services available for non-English speakers.

For more detailed information on your responsibilities as a member of our plan, please read your Evidence of Coverage chapter entitled “Your rights and responsibilities.”

Y0103_WEB_00317v2 — Approved (Updated 06/12/2017)

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