CIGNA HealthCare Member Rights and Responsibilities

As a CIGNA HealthCare member, you have certain rights and responsibilities, as outlined below. Rights or responsibilities that differ according to plan type are noted separately for HMO (managed care) and PPO.

You have the right to:

• Receive medical treatment that is available when you need it and is handled in a way that respects your privacy and dignity
• Get the information you need about your health care plan, including information about services that are covered, services that are not covered and any costs that you will be responsible for paying.
• Have access to a current list of providers in the CIGNA HealthCare network and have access to information about a particular provider's education, training and practice.
• HMO members: Select a Primary Care Physician (PCP) for yourself and each covered member of your family, and change your PCP for any reason.
• Have your medical information kept confidential by CIGNA HealthCare employees and your health care provider. Confidentiality laws and professional rules of behavior allow CIGNA HealthCare to release medical information only when it's required for your care, required by law, or necessary for the administration of your plan or to support CIGNA HealthCare programs or operations that evaluate quality and service. We may also summarize information in reports that do not identify you or any other members specifically.
• Participate with your health care providers in health decisions and have them give you information about your medical condition and your treatment options, regardless of benefits coverage or cost. You have the right to receive this information in terms you understand.
• Learn about any care you receive. You should be asked for your consent for all care, unless there is an emergency and your life and health are in serious danger.
• Refuse medical care. If you refuse medical care, your health care provider should tell you what might happen. We urge you to discuss your concerns about care with your provider. Your practitioner or provider will give you advice, but you'll have the final decision.
• Be heard. Our complaint-handling process is designed to hear and act on your complaint or concern about CIGNA HealthCare and/or the quality of care you receive, provide a courteous, prompt response and guide you through our grievance process if you do not agree with our decision.
• Make recommendations regarding our policies on member rights and responsibilities. If you have recommendations, please call Member Services at the toll-free number on your CIGNA HealthCare ID card.

You have the responsibility to:

• Review and understand the information you receive about your health care plan. Please call CIGNA HealthCare Member Services when you have questions or concerns.
• Understand how to use CIGNA HealthCare services.
• Show your CIGNA HealthCare ID card before you receive care.
• HMO members: Schedule a new patient appointment when you select a new PCP from the CIGNA HealthCare network.
• Build a comfortable relationship with your practitioner or provider, ask questions about things you don't understand and follow your practitioner's or provider's advice. You should understand that your condition may not improve and may even get worse if you don't follow your practitioner's or provider's advice.
• Understand your health condition and work with your practitioner or provider to develop treatment goals that you both agree upon, to the extent that this is possible
• Provide honest, complete information to the providers caring for you.
• Know what medicine you take, why and how to take it.
• Pay all co-payments, deductibles and coinsurance for which you are responsible, at the time service is rendered.
• Keep scheduled appointments and notify your provider's office ahead of time if you are going to be late or miss an appointment.
• Pay all charges for missed appointments and for services that are not covered by your plan.
• Voice your opinions, concerns or complaints to CIGNA HealthCare Member Services and/or your provider.
• Notify your benefits administrator as soon as possible about any changes in family size, address, phone number or membership status.