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Members Rights and Responsibilities
As a member of WPS Health Insurance, we believe you have certain basic
rights and responsibilities regarding your health care.
You Have the Right To:
- Be treated with respect and recognition of your dignity and your right
to privacy. You also have the right to the privacy of your medical information unless you allow the release of such information.
- Participate in any decision
making regarding your health care.
- Have a candid discussion of appropriate or medically necessary treatment
options for your medical condition.
- Receive the right care at the right level at the right time by the right
type of provider for your medical condition.
- Receive information about preventive health care that is age and sex specific,
and information about remaining as healthy as possible including self care
and maintenance care for specific chronic diseases.
- Receive care according to federal and state mandates.
- Voice complaints or appeals about service from WPS Health Insurance or
about care received.
You Have the Responsibility To:
- Provide, to the extent possible, information WPS Health Insurance
and your physician or health care provider need to care for you.
- Be aware of your health care coverage and requirements/limitations under
your certificate of coverage, including , but not limited to, pre-certification
or preauthorization requirements and exclusions.
- Ask questions about your diagnosis, your treatment plan — and how to best
manage your health.
- Follow the plans and instructions for care on which you have agreed with
your physician or other health care provider.
Independent Claims Review
The independent claims review process provides you with an opportunity
to have an independent review organization review your claim dispute.
HIPAA
The Health Insurance Portability and Accountability Act (HIPAA) is designed to make health coverage more portable for individuals
who change jobs or health plans by limiting the coverage exclusions
that can be imposed when such a change occurs.
HIPAA also contains
privacy provisions designed to protect the confidentiality and security
of Protected Health Information (PHI). You can download a variety of important HIPAA forms and documents in the "HIPAA forms" section of this page (right).
ERISA
The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most voluntarily
established pension and health plans in private industry to provide
protection for individuals in these plans.
COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows a qualified beneficiary (e.g., a covered employee, spouse,
and/or dependent), who loses group health coverage due to a qualifying
event, to elect, within the election period, to continue group health
coverage for a period of time on a self-pay basis.
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