Member Rights and Responsibilities
The NHIP prides itself on the care and high-quality customer service delivered to all of its members. Please familiarize your staff and yourself with the member rights listed below so you can provide the best possible care. Both the NHIP and its contracted providers must comply with all requirements regarding member rights.
Members have the right to:
- Be treated with respect and dignity at all times.
- Be protected from discrimination and file or appeal any complaints of discrimination based on race, color, national origin, age, or disability in the receipt of health services.
- Have their personal and health information kept private.
- Receive information from the NHIP and its providers in a manner they can understand.
- Receive all of the services that the NHIP is required to provide.
- Have their questions about their health care and NHIP services answered.
- Have access to doctors, other healthcare providers, specialists, and hospitals.
- Learn about treatment choices in a way they can understand—allowing them to participate in treatment decisions, including the right to refuse treatment.
- Be free from any form of restraint or seclusion that is used as a means of coercion, discipline, convenience, or retaliation.
- Receive a decision about healthcare payment, coverage of services, and prescription drug coverage.
- Request a review (appeal) of specific decisions about healthcare payment, coverage of services, and prescription drug coverage.
- Request and receive a copy of their medical records from providers, as well as request that their medical records be amended or corrected.
- Exercise their rights without fear of reprisal from the NHIP or providers.
- File complaints (grievances), including complaints related to the quality of the care they receive.
Members have the responsibility to:
- Supply information that the NHIP and its providers need to coordinate care.
- Follow plans and instructions for care that they have agreed on with the NHIP and its providers.
- Understand their health problems and participate in developing mutually agreed-on treatment goals.
- Contribute toward their own health care, including exhibiting appropriate behavior.
- Treat providers and NHIP staff with respect.
- Adhere to the processes of the NHIP. These processes are in place to ensure the efficiency and sustainability of the plan while preserving health and promoting beneficiary satisfaction.