Member Rights and Responsibilities

Knowing your rights and responsibilities helps you get the most from your health plan. Rights and responsibilities vary depending on the type of health plan you have.

Your rights as a health plan member:

To be treated with respect, dignity and privacy
To receive quality health care that is friendly and timely
To have available and accessible medically necessary covered services, including emergency services, 24 hours a day, seven (7) days a week
To be informed of your health problems and to receive information regarding treatment alternatives and their risk in order to make an informed choice regardless if the health plan pays for treatment
To participate with your health care providers in decisions about your treatment
To give your provider a health care directive or a living will (a list of instructions about health treatments to be carried out in event of incapacity)
To refuse treatment
To have privacy of medical and financial records maintained by Blue Cross and its health care providers in accordance with existing law
To receive information about Blue Cross, its services, its providers, and your rights and responsibilities
To make recommendations regarding these rights and responsibilities policies
To have a resource at Blue Cross or at the clinic that you can contact with any concerns about services
To file a complaint with Blue Cross and the Commissioner of Commerce and receive a prompt and fair review
To initiate a legal proceeding when experiencing a problem with Blue Cross or its providers

Your responsibilities as a health plan member:

To know your health plan benefits and requirements
To provide, to the extent possible, information that Blue Cross and its providers need in order to care for you
To understand your health problems and work with your doctor to set mutually agreed upon treatment goals
To follow the treatment plan prescribed by your provider or to discuss with your provider why you are unable to follow the treatment plan
To provide proof of coverage when you receive services and to update the clinic with any personal changes
To pay copays at the time of service and to promptly pay deductibles, coinsurance and, if applicable, charges for services that are not covered
To keep appointments for care or to give early notice if you need to cancel a scheduled appointment

Your rights as a health plan member:

To get quality health care that is timely, accessible, and friendly.
To be treated with respect, dignity and consideration for privacy.
To get medically necessary covered services, including emergency services, 24 hours a day, seven (7) days a week.
To be told about your health problems.
To get information about treatments, your treatment choices and how they will help or harm you - whether or not the health plan would pay for these treatments.
To participate with your providers in the decisions about your health care.
To participate in understanding your health problems and developing your treatment goals.
To refuse treatment. To get information about what might happen if you refuse treatment.
To refuse care from specific providers.
To expect that we will keep your medical and financial records private according to the law.
To request and receive a copy of your medical records. You also have the right to ask to correct the records.
Get notice of our decisions if we deny, reduce or stop a service, or deny payment for a service.
To file a grievance or appeal with Blue Plus. You can also file a complaint with the Minnesota Department of Health.
To request a State Fair Hearing with the Minnesota Department of Human Services (also referred to as "the State"). You may request a State Fair Hearing before or at any time during the Blue Plus appeal process. You do not have to file an appeal with Blue Plus before you request a State Fair Hearing.
To get a clear explanation of covered nursing home and home care services.
Give written instructions that inform others of your wishes about your health care. This is called a "health care directive." It allows you to name a person (agent) to decide for you if you are unable to decide, or if you want someone else to decide for you.
To choose where you will get family planning services.
To get a second opinion for medical, mental health and chemical dependency services.
To be free of restraints or seclusion used as a means of coercion, discipline, convenience, or retaliation.
To request a copy of this Certificate of Coverage at least once a year.
To recommend changes regarding Blue Plus' rights and responsibilities policies.
To freely exercise your rights. The exercise of your rights will not adversely affect the way you are treated.
Get the following information from us, if you ask for it:
- Whether we use a physician incentive plan that affects the use of referral services;
- The type(s) of incentive arrangement used;
- Whether stop-loss protection is provided; and
- Results of a member survey if one is required because of our physician incentive plan.
Get the results of an external quality review study from the state, if you ask for them.
To be told when a health care provider cancels their contract with Blue Plus. You may choose from the rest of the Blue Plus providers.
To have a person at Blue Plus or at the clinic to contact with any concerns about services.
To get information about Blue Plus, our services, network of providers, and your rights and responsibilities.
To start a legal proceeding when having a problem with Blue Plus or our providers.
To file a grievance or appeal with Blue Plus and receive a fair and prompt review.
To contact the state ombudsman for help in filing a grievance or appeal.
To ask for a speedy hearing.

Your responsibilities as a health plan member:

Read this Certificate of Coverage and know which services are covered under the Plan and how to get them.
To show your member ID card and your Minnesota Health Care Programs card every time you go for health care. Also show the cards of any other health coverage you have, such as Medicare or private insurance.
To establish a relationship with a Blue Plus primary care doctor before you become ill. This helps you and your primary care doctor understand your total health condition.
To give information that Blue Plus and our providers need to give care to you. Share information about your health history.
To follow all of your doctor’s instructions. If you have questions about your care, you should ask your doctor.
Work with your doctor to understand your total health condition. It is important to know what to do when a health problem occurs, when and where to seek help, and how to prevent heath problems.
To practice preventive health care. To have tests, exams and shots recommended for you based on your age and gender.
To tell the clinic about changes in your name or address.
To keep appointments for care or to give early notice if you need to cancel.

For Blue Advantage and MinnesotaCare members

You have the right to know about your rights and responsibilities. If you have any questions, please call member services at (651) 662-5545 or toll-free at 1-800-711-9862.

Your rights as a health plan member:

To get quality health care that’s timely, accessible, and friendly.
To be treated with respect, dignity and consideration for privacy.
To get medically necessary covered services, including emergency services, 24 hours a day, seven (7) days a week.
To be told about your health problems.
To get information about treatment, your treatment choices and how they will help or harm you – whether or not the health plan would pay for these treatments.
To participate with your providers in the decisions about your health care.
To participate in understanding your health problems and developing your treatment goals.
To refuse treatment. To get information about what might happen if you refuse treatment.
To refuse care from specific providers.
To expect that we will keep your medical and financial records private according to the law.
To request and receive a copy of your medical records. You also have the right to ask to correct the records.
Get notice of our decisions if we deny, reduce or stop a service, or deny payment for a service.
To file a grievance or appeal with Blue Plus. You can also file a complaint with the Minnesota Department of Health.
To request a State Fair Hearing with the Minnesota Department of Human Services (also referred to as “the State”). You may request a State Fair Hearing before or at any time during the Blue Plus appeal process. You do not have to file an appeal with Blue Plus before you request a State Fair Hearing.
To get a clear explanation of covered nursing home and home care service.
Give written instructions that inform others of your wishes about your health care. This is called a “health care directive.” It allows you to name a person (agent) to decide for you if you are unable to decide, or if you want someone else to decide for you.
To choose where you will get family planning services.
To get a second opinion for medical, mental health and chemical dependency services.
To be free of constraints or seclusion used as a means of coercion, discipline, convenience or retaliation.
To request a copy of your Certificate of Coverage at least once a year.
To recommend changes regarding Blue Plus’ rights and responsibilities policies.
To freely exercise your rights. The exercise of your rights will not badly affect the way you are treated.
Get the following information from us, if you ask for it:
- Whether we use a physician incentive plan that affects the use of referral services;
- The type(s) of incentive arrangement used;
- Whether stop-loss protection is provided; and
- Results of a member survey if one is required because of our physician incentive plan.
Get the results of an external quality review study from the State, if you ask for them.
To be told when a health care provider cancels their contract with Blue Plus. You may choose from the rest of the Blue Plus providers.
To have a person at Blue Plus or at the clinic to contact with any concerns about services.
To get information about Blue Plus, our services, network of providers and your rights and responsibilities.
To start a legal proceeding when having a problem with Blue Plus or our providers.
To file a grievance or appeal with Blue Plus and receive a prompt and fair review.
To contact the State ombudsman for help in filing a grievance or appeal.
To ask for a speedy hearing.

Your responsibilities as a health plan member:

To read your Certificate of Coverage and know which services are covered under the Plan and how to get them.
To show your member ID card and your Minnesota Health Care Programs card every time you go for health care. Also show the cards of any other health coverage you have, such as Medicare or private insurance.
To establish a relationship with a Blue Plus primary care doctor before you become ill. This helps you and your primary care doctor understand your total health condition.
To give information that Blue Plus and our providers need to give care to you. Share information about your health history.
To follow all your doctor’s instructions. If you have questions about your care, you should ask your doctor.
Work with your doctor to understand your total health condition. It is important to know what to do when a health problem occurs, when and where to seek help, and how to prevent health problems.
To practice preventive health care. To have tests, exams and shots recommended for you based on your age and gender.
To tell the clinic about changes in your name or address.
To keep appointments for care or to give early notice if you need to cancel.

This information is available in other forms to people with disabilities by calling Blue Plus member services at (651) 662-5545, toll free 1-800-711-9862 (voice), or TTY 711, or through the Minnesota Relay Service at 1-877-627-3848 (speech-to-speech relay service).

Blue Advantage includes Prepaid Medical Assistance and Minnesota Senior Care Plus.