Your Rights and Responsibilities

As an SFHP Healthy Workers HMO member, I have the right to:

• Be treated respectfully regardless of my gender, culture, language, appearance, sexual orientation, race, presence of disability, or transportation ability.
• Receive information about all health services available to me, including a clear explanation of how to obtain them.
• Select a PCP from the SFHP Healthy Workers HMO Program Provider Directory to provide or arrange for all the care I need.
• Receive good and appropriate medical care including preventive health services and health education.
• Participate actively in decisions regarding my medical care. To the extent permitted by law, I also have the right to refuse or discontinue treatment.
• Receive enough information to help me make a knowledgeable decision before I receive treatment.
• Know and understand my medical condition, treatment plan, expected outcome, and the effects these have on my daily living.
• Receive interpreter services at no charge.
• File a complaint or grievance if my linguistic needs are not met.
• Have the meaning and limits of confidentiality explained to me. If I am a minor, I understand that my doctor or other staff may need to talk with my parents or guardian about certain issues. If this happens, the information will be discussed fully with me as well.
• Have confidential health records, except when disclosure is required by law or permitted in writing by me. With adequate notice, I have the right to review my medical records with my PCP.
• Know about any transfer to another hospital, including information as to why the transfer is necessary and any alternatives available.
• Obtain a referral from my PCP for a second opinion.
• Be fully informed about SFHP’s appeals procedure and understand how to use it without fear of interruption of health care and present my appeal in person.
• Participate in establishing public policy of SFHP, as outlined in this Evidence of Coverage.

Member Responsibilities

As a Healthy Workers HMO member, I have the responsibility to:

• Carefully read all SFHP materials immediately after I am enrolled so I understand how to use my SFHP Benefits.
• Ask questions when necessary.
• Follow the provisions of my SFHP membership as explained in this Evidence of Coverage.
• Be responsible for my health.
• Follow the treatment plans my physician develops for me and consider and accept the potential consequences if I refuse to comply with treatment plans or recommendations.
• Ask questions about my medical condition and make certain that I understand the explanations and instructions I am given.
• Make and keep medical appointments and inform my physician ahead of time when I must cancel.
• Communicate openly with my physician so I can develop a strong partnership based on trust and cooperation.
• Offer suggestions to improve SFHP.
• Help SFHP maintain accurate and current medical records by providing timely information regarding changes in address, family status, and other health plan coverage.
• Notify SFHP as soon as possible if I am billed inappropriately or if I have any complaints.
• Treat all SFHP staff and health care professionals respectfully and courteously.
• As required by Healthy Workers HMO program, pay any premiums, co-payments and charges for non-covered services on time.