Member Rights and Responsibilities
It is important that our members understand their rights as Common Ground Healthcare Cooperative (CGHC) members. As a member, you have the right to:
- Receive information about CGHC, its services, its providers and Member rights and responsibilities.
- Be treated with respect and dignity by CGHC employees, contracted providers, vendors, and health care professionals.
- Privacy and confidentiality regarding their health and care.
- Participate with providers in making decisions about their health care.
- A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Voice complaints or concerns about CGHC or any of its network providers.
- Appeal any decision made by CGHC and to receive a response within a reasonable amount of time.
- Make recommendations regarding CGHC’s Member rights and responsibilities policy.
- Choose an advance directive to designate the kind of care they wish to receive should they become unable to express their wishes.
- Have a safe, secure, clean, and accessible health care environment.
- Have access to emergency health care services in cases where a “prudent layperson” acting reasonably would believe that an emergency existed.
Member Responsibilities
Given that the health of Common Ground Healthcare Cooperative members impacts the financial well-being of all CGHC members, those that purchase our insurance also have certain responsibilities. It is the responsibility of all CGHC members to:
- Pay their premiums.
- Comply with all provisions of the policy outlined in the Certificate of Coverage, including Prior Authorization requirements.
- Know and confirm their benefits before receiving treatment.
- Show their ID card before receiving health care services.
- Follow agreed upon instructions and guidelines for care.
- Understand their health problems and develop mutually agreed upon treatment goals, to the degree possible.
- Provide accurate information, to the extent possible, that CGHC and their provider require to care for them, or to make an informed coverage determination.
- Use in-network providers for health care benefits and services, except where services are authorized by their health plan, or in the event of emergencies.
- Pay appropriate co-payments, coinsurance and deductibles to participating providers when services are received.
- Pay full charges incurred for non-covered services; EPO subscribers to pay full charges for out-of-network services; PPO subscribers to pay balance remaining for out of network services.