As a Member of IEHP, you have the right to:

1.   Receive information about your rights and responsibilities as an IEHP Member. 

2.   Be treated with respect and courtesy.  IEHP recognizes your dignity and right to privacy.

3.   Receive information about IEHP, its programs and services, its Doctors, and its providers.

4.   Receive information about IEHP, its staff and its staff qualifications for health management programs and any contractual relationships.

5.   Receive information on how to reach health management staff and to discuss any problems regarding health management and how to request a change.

6.   Receive interpreter services at no cost to you.

7.   Receive medically necessary covered services without regard to race, religion, age, gender, national origin, disability, sexual identity or orientation, family composition or size, or medical condition or stage of illness.

8.   Receive family planning services, services at Federally Qualified Health Centers or Indian Health Centers, sexually transmitted disease (STD) services, and emergency services outside the IEHP network as stated in Federal law.

9.   Receive emergency or urgently needed services outside the IEHP network.

10. Receive emergency care whenever necessary and wherever you need it.

11. Receive sensitive services, such as family planning or mental health care in a confidential way.

12. Access minor consent services (Medi-Cal).

13. Choose a primary care Doctor within the IEHP network.

14. Receive information from IEHP that you can understand.

15. Receive written Member informing materials in alternative formats, including Braille, large print, and audio.

16. Make recommendations about IEHP Members’ rights and responsibilities policies.

17. Participate with Doctors in decision making about your own health care.

18. Talk with your Doctor about your medical condition and appropriate or medically necessary treatment options regardless of the cost or what your benefits are.

19. Decide about your care, including the decision to stop treatment, services, or stop participating in health management programs.

20. Decide in advance how you want to be cared for in case you have a life-threatening illness or injury.

21. Be informed by IEHP regarding advance directives, and to receive information from IEHP regarding any changes to that law.  The information shall reflect changes in state law regarding advance directives as soon as possible, but no later than 90 days after the effective date of change.

22. Review, request corrections to, and receive a copy of your medical records.

23. Keep your personal and medical information and records confidential, unless you say differently, and know how IEHP keeps your information confidential and ensures privacy, and know what entities have access to their information. 

24. Complain about IEHP, its providers, or your care.  IEHP will help you with the process. You may appeal decisions made by IEHP or your Medical Group.  You have the right to choose someone to represent you during the grievance process and for your complaints and appeals to be reviewed as quickly as possible and be told how long it will take.   Medi-Cal Members have the right to request a State Fair Hearing or an expedited Fair Hearing for urgent cases. Call the Department of Social Services Public Inquiry and Response Unit at 1-800-952-5253 or TTY 1-800-952-8349.

25. Have IEHP act as your patient advocate.

26. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.

27. Disenroll from IEHP at any time without giving a reason. 

28. Request a second opinion about a medical condition. 

29. File a grievance with IEHP if your linguistic needs are not met.

30. Request an Independent Medical Review from the Department of Managed Health Care (DMHC) if you disagree with IEHP’s decision to deny, delay, or modify a service your Doctor requests.

31. Request an External Independent Review from IEHP and/or an Independent Medical Review from the Department of Managed Health Care (DMHC) if a service or a therapy was denied on the basis that it was considered experimental or investigational, or related to medical necessity.  If you have any questions about these procedures, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY 1-800-718-4347.

29. If you are a Native American Indian, you have the right to not enroll in a plan, not be restricted by a plan in your right to access Indian Health Facilities, and to disenroll from a plan without cause.

As a Member of IEHP, you have the responsibility to:

1.   Be familiar with and ask questions about your health plan coverage.  If you have a question about your coverage, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY 1-800-718-4347.

2.   Follow the advice and care procedures indicated by your Doctor, IEHP and the programs.  If you have a question about these procedures, call IEHP Member Services at 1-800-440-IEHP (4347) / TTY 1-800-718-4347.

3.   Request interpreter services at least 5 working days before a scheduled appointment.

4.   Call your Doctor or Pharmacy at least 3 days before you run out of medicine.

5.   Cooperate with your Doctor and staff and treat them with respect.  This includes being on time for your visits or calling your Doctor if you need to cancel or reschedule an appointment.

6.   Give accurate information to IEHP, your Doctor, and any other provider.  This helps you receive better care.

7.   Understand your health problems and be a part of your health care decisions.  Ask your Doctor questions if you do not understand.

8.   Work with your Doctor to make plans for your health care.

9.   Follow the plans and instructions for care that you have agreed on with your Doctor.

10. Notify IEHP and your Doctor if you want to stop the plans and instruction you have agreed on or want to stop participating in health management programs.

11. Immunize your children by age 2 years and always keep your children’s immunizations up to date.

12. Call your Doctor when you need routine or urgent health care.

13. Care for your own health.  Live a healthy lifestyle, exercise, eat a good diet, and don’t smoke.

14. Avoid knowingly spreading disease to others.

15. Use IEHP’s grievance process to file a complaint.  Call IEHP Member Services at    1-800-440-IEHP (4347) / TTY 1-800-718-4347 to file a complaint.

16. Report any wrongdoing or fraud to IEHP or the proper authorities.

17. Understand that there are risks in receiving health care and limits to what can be done for you medically.

18. Understand that it is a health care provider’s duty to be efficient and fair in caring for you as well as other patients. 

19. Make a good-faith effort to pay your health care bills (Premiums, co-pays and non-covered services when applicable).