Member Rights

Your right to get information about the organization, its services, its practitioners and providers and member rights and responsibilities:

  • You have a right to ask for information in writing about your rights and responsibilities.
  • You have a right to have information about your health care plan and its services explained to you in a way you will understand, and in a different language if necessary.
  • You have a right to interpreters when you contact Community Health Plan, either by phone or in writing.
  • You have a right to know the name, title, and qualifications of the practitioners, providers, and staff who care for you.
  • You have a right to get information in writing about what you must do to see a provider other than your PCP.
  • You have a right to ask for information in writing about what you must do when you need our okay for health care services.
  • You have a right to get information in writing about Community Health Plan’s structure and operations.
  • You have a right to get information in writing about how we pay doctors and hospitals. You may also get an explanation of how referrals to specialists affect our payment to providers.
  • You have a right to get information in writing about if we pay providers extra for certain care (physician incentive programs). For more information, see Policy Prohibiting Financial Incentives.
  • You have a right to ask for information in writing about which medical service you use and showing how we paid for a service. This is known as an explanation of benefits (EOB). For more information, see Explanation of Benefits.
  • You have a right to request copies of your medical record and ask for changes when necessary.
  • You have a right to know that the government has set standards for safe and effective pharmacy services.
  • You have a right to know what drugs are covered by your insurance. For more information, ask for a copy of the Community Health Plan 2010 Drug Formulary by calling the Community Health Plan customer service team at 1-800-440-1561 toll free. If you are hearing or speech impaired, please call TTY 1-866-816-2479 toll free or local 206-613-8875. You may also get more information in Prescription Drug Services.
  • You have a right to get information in writing about how we report how well we do with your care. We measure our performance using the Healthcare Effectiveness Data Information Set, or HEDIS. You may ask to see the HEDIS data and have someone explain what the information means.


If you want any of the information listed above, contact the Community Health Plan customer service team at 1-800-440-1561 toll free. If you are hearing or speech impaired, please call TTY 1-866-816-2479 toll free or local 206-613-8875.

Your right to be treated with respect and recognition of your dignity and right to privacy:

  • You have a right to be given care and service that go along with your values and beliefs.
  • You have a right to get services without being discriminated against.
  • You have a right to have your medical record and information regarding your health care treated confidentially. For exceptions, see Privacy of Your Health Information.
  • You have a right to expect that Community Health Plan will protect your privacy. (For information about Community Health Plan privacy practices, see the Community Health Plan Notice of Privacy Practices.)
  • You have a right to have your wishes for your future medical care made known to others if you are too sick to let them know. This includes the right to choose a person to make medical decisions for you if you are unable to do so. You can do this with a living will, a durable power of attorney for health care, or both. For more information, see Advance Directives.


Your right to participate with practitioners in making decisions about your health care:

  • You have a right to provide your written okay to have the medical care.
  • You have a right to be told how to make your wishes known about future care. That includes the right to choose a person to make medical decisions for you if you are unable to do so. For more information, see Advance Directives.
  • You have a right to refuse treatment and be told what might happen with your health.
  • You have a right to refuse to take part in experimental research.


Your right to a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage:

  • You have a right to get information about what health care services you can get.
  • You have a right to get information about other health care options available from Community Health Plan.
  • You have a right to get information about what you must do when you need an okay for health care services.
  • You have a right to candidly discuss with your provider the right or medically necessary treatment options for your health condition, including the risks involved, regardless of cost or coverage.
  • You have a right to get a second opinion from another Community Health Plan provider, with an okay by your PCP. For more information, see Getting a Second Opinion.
  • You have a right to be able to speak freely about your health care and concerns without any bad results.


Your right to voice complaints or appeals about the organization or the care it provides:

  • You have a right to tell us your complaints or to appeal decisions about your health care or about Community Health Plan without fear that you may not be able to get care in the future.
  • You have a right to be told about our grievance process when telling us about your complaints. You also have the right to get an answer to your complaint in a timely manner. For more information, see Grievances and Appeals.
  • You have a right to get a copy of our grievance policy. This will tell you how to file an appeal if you disagree with one of our decisions or if you are dissatisfied with your health care.


Your right to make recommendations regarding the organization's member rights and responsibilities policy:

  • You have a right to recommend changes to Community Health Plan policies and procedures, including the policy about your rights and responsibilities and our policy on advance directives. For information about how to recommend changes, call the Community Health Plan customer service team at 1-800-440-1561 toll free. If you are hearing or speech impaired, please call TTY 1-866-816-2479 toll free or local 206-613-8875.


Your right to safe and timely health care:

  • You have a right to get care and service in a safe, comfortable, and clean environment.
  • You have a right to get proper and timely health care, including emergency services, 24 hours a day, seven days a week. For more information, see Appointment Standards.


Your right to choose your providers and your health plan:

  • You have a right to get care from a Community Health Plan provider.
  • You have a right to choose your primary care clinic, ask for a PCP, or change providers as often as once a month, at any time during the month. (The change will be for the first day of the month after you call to change your doctor.) For more information, see Your Primary Care Provider.
  • You have a right to seek care from a Community Health Plan women’s health care provider, without a PCP referral. For more information, see Women’s Health Care.
  • You have a right to change health plans (consistent with the guidelines described in the Washington State 2010 Basic Health Member Handbook).