Enrollee Rights and Responsibilities

Quality health care and benefits are responsibilities you share with your doctors and your plan. We want you to know your responsibilities and rights. They are based on common sense, courtesy, and honest communication. Please read your Evidence of Coverage for a full description. If you have a question, concern, or a recommendation on improving PrimeTime Health Plan policies for promoting enrollee responsibilities and rights, contact us here or call the Service Center at 330-363-7407 or toll free at 1-800-577-5084 or TTY/TDD 330-363-7460 or 1-800-617-7446. Monday through Friday, 8:00 a.m. to 8:00 p.m. From October 1 through February 14, we are open 8:00 a.m. to 8:00 p.m., 7 days a week.

You have a Right to:

  • Receive information about the organization, its services, its practitioners and providers, and member rights and responsibilities.
  • Receive information about your coverage (see your Evidence of Coverage book).
  • A list of doctors, hospitals, and other PrimeTime Health Plan network providers. Visit our Find a Doctor Tool here.
  • Be treated with dignity and respect.
  • A frank discussion with your doctor about your medical condition, including appropriate and medically necessary treatment options, regardless of cost or benefit coverage and to participate in making decisions about your health care. Your doctors are independent. They are not restricted or prohibited from discussing treatment options with you, including those that are not covered.
  • Privacy of your health care and claims information. Your Protected Health Information will be used to pay claims, as permitted by HIPAA and as described in your Notice of Privacy Practices. Protected Health Information will not be disclosed to others without your authorization.
  • Ask questions, raise concerns, make complaints, and appeal denials, as explained in your Evidence of Coverage book.
  • To make recommendations about PrimeTime Health Plan’s Enrollee Rights and Responsibilities Policy.

You have a Responsibility to:

  • Bring your PrimeTime Health Plan ID card when you go to the doctor, hospital, drug store, or health care provider. It contains important information. Having your card may help save time and prevent mistakes.
  • Tell the doctor or nurse about your condition. Tell your doctor what medications you are taking. Answer any questions the doctor or nurse may ask you completely and truthfully. This information may help your doctor form treatment goals and alternatives. Understand your health problems and participate in developing mutually agreed upon goals.
  • Ask questions if you do not understand something about your medical condition and the treatment alternatives (including medications) the doctor is recommending.
  • Follow your doctor’s medical advice and instructions. Take medications as directed. Let the doctor know if you have a bad reaction. Let your doctor know if your symptoms do not get better, or if they get worse. Schedule recommended follow-up appointments.
  • Live a healthy lifestyle.
  • Check your benefit chart (schedule of benefits).
  • Get all required pre-approvals (pre-certification) and second opinions.
  • Call PrimeTime Health Plan if you have questions about your coverage or responsibilities.
Last updated: 10/01/2017