Member Rights & Responsibilities

Your Rights

As a member of Nascentia Health Plus you have a right to:

• receive medically necessary care;
• timely access to care and services;
• privacy about your medical record and when you get treatment;
• get information on available treatment options and alternatives presented in a manner and language you understand;
• get information in a language you understand; you can get oral translation services free of charge;
• get information necessary to give informed consent before the start of treatment;
• be treated with respect and dignity;
• get a copy of your medical records and ask that the records be amended or corrected;
• take part in decisions about your health care, including the right to refuse treatment;
• be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation;
• get care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status or religion;
• be told where, when and how to get the services you need from your managed long term care plan, including how you can get covered benefits from out-of-network providers if they are not available in the plan network;
• complain to the New York State Department of Health or your Local Department of Social Services; and, the Right to use the New York State Fair Hearing System and/or a New York State External Appeal, where appropriate; and
• appoint someone to speak for you about your care and treatment.
• Seek assistance from the Participant Ombudsman program
• Make advance directives and plans about your care

Your Responsibilities

As a member of Nascentia Health Plus you agree to:

• work with your Care Manager to become as independent and self-managing as possible;
• find out how your health care system works;
• listen to your health care provider’s advice and ask questions when you are in doubt;
• treat health care staff with the respect you expect yourself;
• tell us if you have problems with any health care staff;
• keep your appointments. If you must cancel, call as soon as you can.;
• use the emergency room only for real emergencies;
• call your health care providers when you need medical care, even if it is after-hours;
• use Providers who work with Nascentia Health Plus for covered services;
• Receive all your covered services from the Nascentia Health Plus Provider Network
• contact your Care Manager any time you use the emergency room, are hospitalized, get new prescriptions or receive a referral to another medical provider; and
• tell us when you plan to be out of town so we can help you arrange services
• tell us when you believe there is a need to change your person-centered service plan

Medicare Advantage Disenrollment (Leaving the Plan) Rights & Responsibilities

"Disenrollment" means ending your membership in Nascentia Health’s Medicare Advantage plans. You can choose to return to Original Medicare and will need to select a separate Medicare prescription drug plan. Your new plan coverage will begin on the first day of the month after we receive your request.

You may not enroll in a new plan during other times of the year unless you meet certain exceptions, such as moving out of the plan’s service area, joining a plan in your area with a 5-star rating, or qualifying for extra help with your prescription drug costs.

Upon disenrollment, you will receive a letter confirming your request, information about Medigap rights (if returning to Original Medicare), and the date your plan coverage will end. You must continue to receive all medical care from Nascentia Health Plus participating providers until the date noted. We will notify you if Medicare denies your disenrollment request.

If your new plan does not include creditable prescription drug coverage (coverage that is at least as good as Medicare’s), you may pay a penalty if you join a Medicare drug plan later.

Nascentia Health Plus must end your membership in our plan in certain situations:

• If you do not stay continuously enrolled in Medicare Part A and Part B
• If you move out of our service area
• If you are more than 90 days behind in your premium payment
• If you are required to pay the extra Part D amount to Medicare because of your income and you do not pay it

Please refer to your Evidence of Coverage for more information. If we end your membership, we will send you our reasons in writing. We cannot ask you to leave our plan for any health-related reason.

If you have any questions, please contact Member Services: 1-888-477-0090 (TTY: 711).

Last Updated on August 18, 2024