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Rights and Responsibilities

Your rights

California Health & Wellness members have these rights:

  • To be treated with respect, giving due consideration to your right to privacy and the need to maintain confidentiality of your medical information.
  • To be provided with information about the plan and its services, including covered services, its practitioners and providers and member rights and responsibilities.
  • To be able to choose a primary care provider within California Health & Wellness's network.
  • To have timely access to network providers.
  • To participate in decision making regarding your own health care, including the right to refuse treatment.
  • To voice grievances, either verbally or in writing, about the organization or the care you got.
  • To get care coordination.
  • To ask for an appeal of decisions to deny, defer or limit services or benefits.
  • To get free oral interpretation services for your language.
  • To get free legal help at your local legal aid office or other groups.
  • To formulate advance directives.
  • To ask for a State Hearing if a service or benefit is denied and you have already filed an appeal with California Health & Wellness and are still not happy with the decision, or if you did not get a decision on your appeal after 30 days, including information on the circumstances under which an expedited hearing is possible.
  • To disenroll from California Health & Wellness and change to another health plan in the county upon request.
  • To access Minor Consent Services.
  • To get written member-informing materials in alternative formats (such as braille, large-size print and audio format) upon request and in a timely fashion appropriate for the format being requested and in accordance with Welfare & Institutions Code Section 14182 (b)(12).
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To truthfully discuss information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand, regardless of cost or coverage.
  • To make recommendations regarding the plan's member rights and responsibilities policy.
  • To have access to and get a copy of your medical records, and request that they be amended or corrected, as specified in 45 Code of Federal Regulations §164.524 and 164.526.
  • Freedom to exercise these rights without adversely affecting how you are treated by California Health & Wellness, your providers or the State.
  • To have access to family planning services, Freestanding Birth Centers, Federally Qualified Health Centers, Indian Health Clinics, midwifery services, Rural Health Centers, sexually transmitted infection services and emergency services outside California Health & Wellness's network pursuant to the federal law.

Your responsibilities

California Health & Wellness members have these responsibilities:

  • Act courteously and respectfully. You are responsible for treating your doctor and all Providers and staff with courtesy and respect. You are responsible for being on time for your visits or calling your doctor's office at least 24 hours before the visit to cancel or reschedule.
  • Give up-to-date, accurate and complete information. You are responsible for giving correct information and as much information as you can to all of your providers, and to California Health & Wellness. You are responsible for getting regular check-ups and telling your doctor about health problems before they become serious.
  • Follow your doctor's advice and take part in your care. You are responsible for talking over your health care needs with your doctor, developing and agreeing on goals, doing your best to understand your health problems, and following the treatment plans and instructions you both agree on.
  • Use the Emergency Room only in an emergency. You are responsible for using the emergency room in cases of an emergency or as directed by your doctor. Emergency care is a service that you reasonably believe is necessary to stop or relieve sudden serious illnesses or symptoms, and injury or conditions requiring immediate diagnosis and treatment.
  • Report wrong-doing. You are responsible for reporting health care fraud or wrong-doing to California Health & Wellness. You can do this without giving your name by calling the California Health & Wellness Fraud and Abuse Hotline toll- free at 1-866-685-8664. The Fraud and Abuse Hotline operates 24 hours a day, seven days a week. All calls are strictly confidential.