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Member Rights and Responsibilities

Your Rights and Responsibilities

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

  • We must provide information in a way that works for you (in Braille, in large print, or other alternate formats, etc.).
  • 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. 
  • We must support your right to make decisions about your care. 
  • 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 (TTY/TDD 800-537-7697).
  • If it is about something else:
  • Call Navigation Services at 866-798-2273.
  • 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:

There are several places where you can get more information about your rights. 

  • You can call Navigation Services at 866-798-2273 (TTY/TDD: 711). 
  • You can call the State Health Insurance Assistance Program at 800-722-4134.
  • You can contact Medicare.

What are your 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. 

For more detailed information on your responsibilities as a member of our plan, please read your Evidence of Coverage.

FamilyCare Health is an HMO with a Medicare and Oregon Health Plan (Medicaid) contract. Enrollment in FamilyCare Health Medicare Advantage plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. If you enroll in FamilyCare Community (HMO SNP), the Oregon Health Plan will pay your Part B premium for you. FamilyCare Community (HMO SNP) is available to people who qualify for Medicare and the Oregon Health Plan (Medicaid). Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

Y0103_WEB_00354 — Approved (Updated 10/05/2017)

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