Customers’ Rights and Responsibilities Statement

You Have the Right to:

• Receive coverage for the benefits and treatment available under your health benefit plan when you need it and in a way that respects your privacy and dignity.
• Receive the understandable information you need about your health benefit plan including information about services that are covered and not covered and any costs that you will be responsible for paying.
• Obtain understandable information about our programs and services, including the qualifications of staff that support our wellness and similar programs and any contractual relationships related to such programs.
• Have access to current information on in-network doctors, health care providers, hospitals and places you can receive care and information about a particular health care provider’s education, training and practice.
• Select a primary care doctor for yourself and each covered member of your family, and change your primary care doctor for any reason. However, many benefit plans do not require that you select a primary care doctor.
• Have your personal identifiable data and medical information kept confidential by Evernorth and your health care provider, know who has access to your information, and know the procedures used to ensure security, privacy and confidentiality. We honor the confidentiality of our customers’ information and adhere to all federal and state regulations regarding confidentiality and the release of personal health information.
• Participate with your health care provider in health decisions and have your health care provider give you information about your condition and your treatment options, regardless of coverage or cost. You have the right to receive this information in terms and language 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 or behavioral care. If you refuse care, your health care provider should tell you what might happen. We urge you to discuss your concerns about care with your doctor or other health care provider. Your doctor or health care provider will give you advice, but you will have the final decision.
• Be advised of who is available to assist you with any special Evernorth programs or services you may receive and who can assist you with any requests to change or disenroll from programs or services offered by or through Evernorth.
• Be heard. Our complaint-handling process is designed to: Hear and act on your complaint or concern about Evernorth and/or the quality of care you receive from health care providers and the various places you receive care in our network; provide a courteous, prompt response; and guide you through our grievance process if you do not agree with our decision. Evernorth strives to resolve your complaint on initial contact and in a manner that is consistent with your applicable benefit plan. Language interpretation and TTY services are available for complaint and appeal processes.
• Know and make recommendations regarding our policies that affect your rights and responsibilities. If you have recommendations or concerns, please call Customer Service at the toll-free number on your ID card.

Statement on confidentiality of alcohol and drug use records:

Evernorth Behavioral Health staff and network practitioners will not identify a participant as involved in alcohol or substance use treatment to others outside the treatment program, unless:

• The participant consents in writing; OR
• The disclosure is allowed by court order; OR
• The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation; OR
• The disclosure is made to a primary care physician to coordinate care when required by a health plan and the participant consents verbally or in writing; OR
• The participant commits or threatens to commit a crime at the treatment program or against any person who works for the program; OR
• There is suspected child abuse or neglect or a danger to yourself or others when reporting is permitted or required under state laws to appropriate state or local authorities.

You Have the Responsibility to:

• Review and understand the information you receive about your health benefit plan. Please call Customer Service when you have questions or concerns.
• Understand how to obtain services and supplies that are covered under your plan - including any emergency services needed outside of normal business hours or when you are away from your usual place of residence or work, by using the indicated number on your ID card or by accessing our on-line resources.
• Show your ID card before you receive care.
• Schedule a new patient appointment with any in-network health care provider; build a comfortable relationship with your health care provider; ask questions about things you don’t understand; and follow your health care provider’s advice. You should understand that your condition may not improve and may even get worse if you don’t follow your health care provider’s advice.
• Understand your health condition and work with your health care provider to develop treatment goals that you both agree upon and to follow the treatment plan and instructions.
• Provide honest, complete information to the health care providers caring for you.
• Know what medicine you take, why, and how to take it.
• Pay all copays, deductibles and coinsurance for which you are responsible, at the time service is rendered or when they are due.
• Keep scheduled appointments and notify the health care 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 Customer Service and/or your health care provider.
• Notify your plan administrator and treating health care provider as soon as possible about any changes in family size, address, phone number or status with your health benefit plan, or if you decide to disenroll from our programs and services.