PRIVACY NOTICES

Your right to the privacy of your medical records and personal health information
There are federal and state laws that protect the privacy of your medical records and personal health information. We keep your personal health information private as protected under these laws. Any personal information that you give us when you enroll in this plan is protected. We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care.

The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to look at your medical records, and to get a copy of the records (there may be a fee charged for making copies). You also have the right to ask plan providers to make additions or corrections to your medical records (if you ask plan providers to do this, they will review your request and figure out whether the changes are appropriate). You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services at 1-866-634-CCHP (2247), *TTY/TDD: 1-866-516-9366, Monday through Sunday, 8am to 8pm, PST, 7 days a week.

Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time
As explained in the Citizens Choice Healthplan HMO Evidence of Coverage booklet, you will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of Citizens Choice Healthplan HMO. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). You have the right to go to a women’s health specialist (such as a gynecologist) without a referral. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. You also have the right to timely access to your prescriptions at any network pharmacy. “Timely access” means that you can get appointments and services within a reasonable amount of time. Section 3 of the Citizens Choice Healthplan HMO’s Evidence of Coverage explains how to use plan providers to get the care and services you need. Section 2 of the Evidence of Coverage explains your rights to get care for a medical emergency and urgently needed care.

Your right to know your treatment choices and participate in decisions about your health care
You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. Your providers must explain things in a way that you can understand. Your rights include knowing about all of the treatment choices that are recommended for your condition, no matter what they cost or whether they are covered by Citizens Choice Healthplan HMO. This includes the right to know about the different Medication Management Treatment Programs we offer and which you may participate. You have the right to be told about any risks involved in your care. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments.

You have the right to receive a detailed explanation from us if you believe that a plan provider has denied care that you believe you are entitled to receive or care you believe you should continue to receive. In these cases, you must request an initial decision. "Initial decisions" are discussed in Sections 4 and 5 of your Citizens Choice Healthplan HMO Evidence of Coverage.

You have the right to refuse treatment. This includes the right to leave a hospital or other medical facility, even if your doctor advises you not to leave. This includes the right to stop taking your medication. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.

Your right to use advance directives (such as a living will or a power of attorney)
You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. If you want to, you can use a special form to give someone you trust the legal authority to make decisions for you if you ever become unable to make decisions for yourself. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." There are different types of advance directives and different names for them. Documents called "living will" and "power of attorney for health care" are examples of advance directives.

If you decide that you want to have an advance directive, there are several ways to get this type of legal form. You can get a form from your lawyer, from a social worker, from Citizens Choice Healthplan HMO or from some office supply stores. You can sometimes get advance directive forms from organizations that give people information about Medicare, such as the Health Insurance Counseling and Advocacy Program (HICAP). Section 8 of the Citizens Choice Healthplan HMO Evidence of Coverage tells how to contact HICAP. Regardless of where you get this form, keep in mind that it is a legal document. You should consider having a lawyer help you prepare it. It is important to sign this form and keep a copy at home. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you can’t. You may want to give copies to close friends or family members as well. If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. If you have signed an advance directive, and you believe that a doctor or hospital has not followed the instructions in it, you may file a complaint with the:

Medical Board of California
Central Complaint Unit
1426 Howe Ave., Suite 54
Sacramento, CA 95825- 3236

Your right to make complaints
You have the right to make a complaint if you have concerns or problems related to your coverage or care. Appeals and grievances are the two different types of complaints you can make. Which one you make depends on your situation. Appeals that involve your Medicare health benefits under Citizens Choice Healthplan HMO are discussed in Section 5 of the Citizens Choice Healthplan HMO Evidence of Coverage.

Appeals and grievances that involve the Citizens Choice Healthplan HMO drug benefit are discussed in sections 4 and 5 of the Citizens Choice Healthplan HMO Evidence of Coverage. If you make a complaint, we must treat you fairly (i.e., not discriminate against you) because you made a complaint. You have the right to get a summary of information about the appeals and grievances that members have filed against Citizens Choice Healthplan in the past. To get this information, call Member Services at 1-866-634-CCHP (2247), *TTY/TDD: 1-866-516-9366, Monday through Sunday, 8am to 8pm, PST, 7 days a week.