Your Rights and Responsibilities

AmeriHealth Caritas VIP Care Plus must honor your rights as a member of the plan.

Rights

  • You have the right to get information from AmeriHealth Caritas VIP Care Plus in a way that works for you (including in languages other than English, in Braille, in large print, or in other alternate formats).
  • You have the right to be treated with fairness and respect at all times.
  • You have the right to get timely access to your covered services and drugs.
  • You have the right to have the privacy of your personal health information protected.
  • You have the right to get information about the plan, its network of providers, and your covered services.
  • You have the right to make decisions about your care and for AmeriHealth Caritas VIP Care Plus to support those decisions.
  • You have the right to make complaints and to ask us to reconsider decisions we have made.
  • You have the right to disenroll from the plan.
  • You have the right to know your treatment options and participate in decisions about your health 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 receive information in accordance with 42 CFR §438.10.
  • You have the right to be treated with dignity and respect.
  • You have the right to be afforded privacy and confidentiality in all aspects of care and for all health care information, unless otherwise required by law.
  • You have the right to request and receive a copy of your medical records, and request that they be amended or corrected.
  • You have the right to be furnished health care services in accordance with 42 CFR §438.206 through §438.210.
  • You have the right to be informed that the plan shall comply with any other applicable federal and MDHHS laws (including Title VI of the Civil Rights Act of 1964 as implemented by regulations at 45 CFR part 80, the Age Discrimination Act of 1975 as implemented by regulations at 45 CFR part 91, the Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972 (regarding education programs and activities), Titles II and III of the Americans with Disabilities Act, and section 1557 of the Patient Protection and Affordable Care Act.
  • You have the right not to be discriminated against based on race, ethnicity, national origin, religion, sex, age, sexual orientation, medical or claims history, mental or physical disability, genetic information, or source of payment.
  • You have the right to have all plan options, rules, and benefits fully explained, including through the use of a qualified interpreter if needed.
  • You have the right to access an adequate network of primary and specialty providers who are capable of meeting your needs with respect to physical access, communication and scheduling needs, and are subject to an ongoing assessment of clinical quality including required reporting.
  • You have the right to choose a plan and provider at any time, including a plan outside of the Demonstration, and have that choice be effective the first calendar day of the following month when that application is received before the last five calendar days of the month. Applications received during the last five calendar days of the month will result in Enrollments with an effective date the first calendar day of the next month after the following month. For example, an application received on March 28 will only be effective May 1.
  • You have the right to have a voice in the governance and operation of the integrated system, provider or health plan, as detailed in the Contract.
  • You have the right to participate in all aspects of care, including the right to refuse treatment, and to exercise all rights of Appeal.
  • You have the right to be fully involved in maintaining your health and making decisions about your health care, including the right to refuse treatment if desired, and must be appropriately informed and supported to this end. Specifically:
    • You have the right to receive a health risk assessment (HRA) upon enrollment in the plan and to participate in the development and implementation of the individual integrated care and supports plan (IICSP). The assessment must include considerations of social, functional, medical, behavioral, wellness and prevention domains, an evaluation of your goals, preferences, strengths and weaknesses, and a plan for managing and coordinating your care. You or your authorized representative, also have the right to request a reassessment by the integrated care team (ICT) and be fully involved in any such reassessment.
    • You have the right to receive complete and accurate information on your health and functional status by the integrated care team (ICT).
    • You have the right to be provided information on all program services and health care options, including available treatment options and alternatives, presented in a culturally appropriate manner, taking into consideration your condition and ability to understand. An member who is unable to participate fully in treatment decisions has the right to designate a representative. This includes the right to have translation services available to make information appropriately accessible. Information must be available before enrollment, at enrollment, and at the time an member’s needs necessitate the disclosure and delivery of such information in order to allow the member to make an informed choice.
  • You have the right to be encouraged to involve caregivers or family members in treatment discussions and decisions.
  • You have the right to have advance directives explained and to establish them, if you so desire, in accordance with 42 CFR §§489.100 and 489.102.
  • You have the right to receive reasonable advance notice, in writing, of any transfer to another treatment setting and the justification for the transfer.
  • You have the right to be afforded the opportunity to file an appeal if services are denied that you think is medically indicated, and to be able to ultimately take that appeal to an independent external system of review.
  • You have the right to receive medical and non-medical care from a team that meets your needs, in a manner that is sensitive to your language and culture, and in an appropriate care setting, including the home and community.
  • You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in federal regulations on the use of restraints and seclusion.
  • You have the right to exercise your member’s rights, and the exercise of those rights does not adversely affect the way the plan, the network providers or the State Agency treating you.
  • You have the right to receive timely information about plan changes. This includes the right to request and obtain the information listed in the orientation materials at least once per year, and the right to receive notice of any significant change in the information provided in the orientation materials at least 30 calendar days prior to the intended effective date of the change.
  • You have the right to be protected from liability for payment of any fees that are the obligation of the plan.
  • You have the right not to be charged any cost sharing for any demonstration services.
  • You have the right to be provided information on how to contact their care coordinator.

You also have some responsibilities as a member of our plan.

Responsibilities

  • If you have any other health insurance coverage or prescription drug coverage besides our plan, you are required to tell us.
  • Tell your primary care provider (PCP) and other health care providers that you are enrolled in our plan. Show your plan membership card and your Medicaid card whenever you get your medical care or Part D prescription drugs.
  • Help your doctors and other providers help you by giving them information, asking questions, and following through on your care.
  • Be considerate. We expect all our members to respect the rights of other patients. We also expect you to act in a way that helps the smooth running of your doctor's office, hospitals, and other offices.
  • Pay what you owe. As a plan member, you are responsible for these payments:
    • Medicare Part A and Medicare Part B premiums. For almost all AmeriHealth Caritas VIP Care Plus members, Michigan Medicaid pays for your Part A premium and for your Part B premium.
    • A Patient Pay Amount (PPA) for nursing facility services as determined by the Michigan Department of Health and Human Services.
    • If you get any services or drugs that are not covered by our plan, you must pay the full cost.
    • If you disagree with our decision to not cover a service or drug, you can make an appeal.
  • Tell us if you move. If you are going to move, it's important to tell us right away. Call Member Services at 1-888-667-0318 (TTY 711), 8 a.m. to 8 p.m., seven days a week.
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Members 2024