Member Rights and Responsibilities

Magnolia Health members have the following rights:

  • To be treated with respect and with due consideration for his/her dignity and privacy.
  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s ability to understand.
  • To participate in decisions regarding his/her health care, including the right to refuse treatment.
  • To complete information about their specific condition and treatment options, regardless of cost or benefit coverage.
  • To seek second opinions.
  • To obtain information about available experimental treatments and clinical trials and how such research can be accessed.
  • To obtain assistance with care coordination from the PCP’s office.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in the Federal regulations on the use of restraints and seclusion.
  • To express a concern or appeal about Magnolia Health or the care it provides and receive a response in a reasonable period of time.
  • To be able to request and receive a copy of his/her medical records, (one copy free of charge) and request that they be amended or corrected.
  • To choose his/her health professional to the extent possible and appropriate, in accordance with federal code.
  • To receive healthcare services that are accessible and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
  • To receive all information— e.g., enrollment notices, informational materials, instructional materials, available treatment options and alternatives—in a manner and format that is easily understood as defined in the provider agreement and this member handbook.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
  • To be notified that interpretation services are available and how to access those services.

Magnolia Health members have the following responsibilities:

  • To inform Magnolia Health of the loss or theft of an ID card.
  • Present the Magnolia Health ID card when using healthcare services.
  • Be familiar with Magnolia Health procedures to the best of the member’s abilities.
  • To call or contact Magnolia Health to obtain information and have questions clarified.
  • To provide participating network providers with accurate and complete medical information.
  • Following the prescribed treatment of care recommended by the provider or letting the provider know the reasons the treatment cannot be followed, as soon as possible.
  • To make every effort to keep any agreed upon appointments, and follow-up appointments; and accessing preventive care services.
  • To live healthy lifestyles and avoid behaviors known to be detrimental.
  • To provide accurate and complete information to all healthcare providers.
  • To become knowledgeable about Magnolia Health coverage provisions, rules and restrictions.
  • To ask questions of providers to determine the potential risks, benefits, and costs of treatment alternatives, and then making care decisions after carefully weighing all pertinent factors.
  • To follow the grievance process established by Magnolia Health (and outlined in the member handbook) if there is a disagreement with a provider.
  • To notify Magnolia and/or DOM if family size changes, if you move out of state, have a change of address or obtain health coverage under another policy or changes to coverage.