Consumer Rights and Responsibilities

You have a right to:

• Be treated with courtesy and respect.
• Get quality health care.
• Get care from qualified medical personnel.
• Choose a primary care doctor or pediatrician you trust, and change doctors if you are not satisfied.
• Get an interpreter when English is not your first language.
• Get an appointment when you need one.
• Understand your health problem.
• Understand the risks and benefits of your treatment choices.
• Get a second opinion about a diagnosis or treatment.
• Choose or refuse treatment.
• Have your health information protected.
• Get a copy of your medical records.

Learn the rules for your policy:

• Read your health plan's Summary of Benefits to learn what is covered and what is not covered (excluded).
• Your insurance only pays for care that is medically necessary. This is defined in your insurance policy.
• Your plan may not pay for care that is experimental or investigational. But if you have a serious illness and feel that you need an experimental or investigational treatment, you can ask for an independent medical review.
• You may need to get pre-approval from your health plan for some kinds of care.
• You do NOT need pre-approval for emergency care.
• Health plans must cover Essential Health Benefits. These include specific treatments or services mandated by the State.
• For more information about the rules for plans regulated by the California Department Managed Health Care (HMOs and certain PPOs), go to www.dmhc.ca.gov.
• Self-insured plans follow different rules. For more information, see your policy or go to www.dol.gov.ebsa.