Unison Health Plan
of Delaware

Rights and Responsibilities

Member Rights

As a Member of Unison Health Plan, you have the following rights:

To pick your own primary care physician (PCP) within the Unison provider network.
To ask for and get information about Unison, our services, participating practitioners, providers’ and members’ rights and responsibilities and how to use Unison benefits.
To get quality health care and be treated with respect and due consideration for your dignity and privacy.
To know the names, titles and educational backgrounds of all physicians and others helping you.
To understand your medical and health needs, what should be done for you, what choices you have and what risks are involved.
To receive free language assistance if you speak another language or are hearing impaired.
To say no to treatment and to take the responsibility for the consequences of saying no to treatment.
To not have your medical records shown to others without your approval, unless permitted by law, and be told who has been given a copy of your medical records.
To have your privacy respected during an office visit, when getting treatment or when talking to Unison.
To see all your medical records in accordance with applicable Federal and State laws, have these records kept private.
To ask that corrections be made to your medical records if you notice a mistake.
To have an advance directive.
To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
To make recommendations to improve Unison’s procedures, policies, rights and responsibilities.
To get a second opinion from a qualified participating provider or a non-participating provider, if a participating provider is not available.
To be told in writing when any of your covered services are reduced, suspended, terminated or denied.
To file an appeal regarding any medical or administrative decisions if you disagree.
To be sure your PCP and the staff of Unison know your rights.
To have these rights regardless of gender, culture, economic status, education, race, ethnicity, age, national origin, sexual orientation, physical or mental disability, type of illness or condition, ability to pay, ability to speak English or religious background.
To receive information on treatment options, alternatives and costs whether the treatment is covered by Unison or not.
To know how Unison pays providers, controls costs and makes decisions about which services are covered.
To get emergency care without having to get a prior approval when you have a true medical emergency.

Member Responsibilities

As a Member of Unison Health Plan, you have the following responsibilities:

To let Medicaid, Delaware Healthy Children’s Program (DHCP) and Unison know if you or a family member changed a name, address or phone number.
To let Medicaid, DHCP and Unison know if you have a change in family size, if you or a family member loses a job or changes jobs, if a member becomes employed or if you have other health insurance.
To call the local Medicaid office in the county where you live and give them all of your new information if it changes.
To respect the doctors, staff and people giving you health care services.
To be sure that you are the only one who uses your Unison identification card and to let Unison know if it is lost or stolen.
To be sure to show your Unison and Medicaid ID cards each time you have a doctor’s appointment; if you have any other health care insurance, you must show your PCP the card for that too.
To be sure to go to your assigned PCP for all of your non-emergency health care unless your PCP sends you to a specialist for care; if you are pregnant and do not wish to go to your PCP, you may go to an obstetrician/ gynecologist who works with Unison.
To ask questions if you do not understand what the health care providers are saying to you.
To answer all questions and provide all information about your health that will help your PCP take care of you.
To follow instructions given to you by your PCP.
To keep your scheduled health care appointments.
To schedule and keep wellness check-ups, including EPSDT (Well Child) appointments for members under 21 years of age.
To get care as soon as you learn you are pregnant and keep all pregnancy appointments.
To give your doctor a copy of any advance directives, including a living will.
To be on time and call your PCP’s office at least 24 hours in advance, when possible, if you need to cancel an appointment.
To let your PCP know when you went to the emergency room, or have someone do it for you, within 24 hours of emergency care.
To let us know if you have another insurance company that is going to pay for your medical care for any reason (health, auto, home or workers’ compensation, for example).
To give your O.K. for us to use your health information.

Rights and ResponsibilitiesMember Rights

Member Responsibilities

Rights and Responsibilities

Member Rights