Member Rights and Responsibilities

WellFirst Health members deserve the best service and health care possible. WellFirst Health Plan is committed to maintaining a mutually respectful relationship with its members.

Rights and responsibilities help foster cooperation among members, practitioners and WellFirst Health Plan. These Member Rights and Responsibilities, outlined below, also appear annually in the WellFirst Health Plan provider and member newsletters.

WellFirst Health members have the right to:

  • Be treated with respect and recognition of their dignity and their right to privacy.
  • Receive a listing of WellFirst Health Plan’s participating practitioners in order to choose a primary care provider.
  • Present a question, complaint, or grievance to WellFirst Health about the organization or the care it provides without fear of discrimination or repercussion.
  • Receive information on procedures and policies regarding their health care benefits.
  • Timely responses to requests regarding their health care plan.
  • Request information regarding Advance Directives.
  • Participate with practitioners 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.
  • Receive information about the organization, its services, its practitioners and providers, and members’ rights and responsibilities.
  • Make recommendations regarding the organization’s members’ rights and responsibilities policies.
  • Receive a copy of the WellFirst Health Notice of Privacy Practices, which describes how medical information about you may be used or disclosed and how you can get access to this information.

WellFirst Health members have the responsibility to:

  • Read and understand the materials provided by WellFirst Health Plan concerning their health care benefits. We encourage members to contact WellFirst Health Plan if they have any questions.
  • Present their ID card in order to identify themselves as WellFirst Health Plan members before receiving health care services.
  • Notify WellFirst Health Plan of any enrollment status changes such as family size or address.
  • Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
  • Follow plans and instructions for care that they have agreed on with their practitioners.
  • Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
  • Fulfill financial obligations as it relates to any copays, deductibles and/or premiums as outlined in your policy.