Your Rights
As an FEHBP Healthcare plan participant, you have the right to:
- Be provided with information about your plan, its services and benefits, its providers, and your member's rights and responsibilities.
- Choose your primary care physician from the network of affiliated physicians and to change to another primary care physician in the network of participating providers.
- Privacy and confidentiality regarding your medical care and records. Records pertaining to your healthcare will not be released without your or your authorized representative's written permission, except as required by law.
- Discuss your medical record with your physician, and receive upon request a summary copy of that record.
- Be informed of your diagnosis, treatment choices, including non-treatment, and prognosis in terms you can reasonably expect to understand, and to participate in decision-making about your healthcare and treatment plan.
- Have a candid discussion with your practitioner about appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
- Expect reasonable access to medically necessary healthcare services regardless of race, national origin, religion, physical abilities, or source payment.
- File a formal complaint, as outlined in the plan's grievance procedure, and to expect a response to that complaint within a reasonable period of time. For more information on this process, contact Humana Customer Service.
- Be treated with courtesy and respect, with appreciation for your dignity and protection of your right to privacy.
- Receive assistance from Customer Service for concerns and questions.
The Right of Self Determination
Today, many people are concerned about the medical care they would be given should they become terminally ill and unable to communicate. Under the Patient Self-Determination Act (PSDA), you have the right to make your own decisions concerning healthcare – including the right to accept or refuse medical or surgical treatment, even if that treatment is life-sustaining. Humana has an Advance Directives brochure that explains this in more detail, but basically, you have the right to:
- Accept or refuse medical or surgical treatment; and
- When you are still healthy, to write down your wishes regarding the care you would want to receive should you become seriously ill or incapacitated and unable to make such decisions.
Talk to your PCP for more information about these rights. For a copy of this brochure, please call Humana Customer Service.
Your Medical Information is Kept Confidential by Humana
In order for the plan to operate, it may be necessary from time to time for healthcare professionals, the Plan Administrator, individuals who perform plan-related functions under the auspices of the Plan Administrator, Humana and other service providers that have been engaged to assist the plan in discharging its obligations with respect to delivery of benefits, to have access to what is referred to as your medical records and other individually identifiable health information about you. This information will only be used or disclosed for purposes of plan operation or benefits delivery. In that regard, only the minimum necessary disclosure will be allowed.
Humana will safeguard confidential medical information in its possession and will not disclose it improperly. Disclosure for plan purposes to persons authorized to receive confidential medical information may be proper, so long as the disclosure is allowed by law and appropriate under the circumstances. Improper disclosure includes disclosure to the employer for employment purposes, employee representatives, consultants, attorneys, relatives, etc. who have not executed appropriate agreements effective to authorize such disclosure.
Your Responsibilities
As an FEHBP health plan participant, you also have the responsibility to:
- Give the Humana plan and your healthcare provider complete and accurate information needed in order to care for you.
- Read and be aware of all material distributed by the plan and your employer explaining policies and procedures regarding services and benefits.
- Obtain and carefully consider all information you may need or desire in order to give informed consent for a procedure or treatment.
- Follow the treatment plan agreed on with your healthcare provider, and to weigh the potential consequences of any refusal to observe those instructions or recommendations.
- Be considerate and cooperative in dealing with the plan providers and to respect the rights of fellow plan members.
- Schedule appointments, arrive on time for scheduled visits, and notify your healthcare provider if you must cancel or be late for a scheduled appointment.
- Express opinions, concerns, or complaints in a constructive manner.
- Contact your Human Resources office if you move or change your address or phone number, even if these changes are only temporary.
- Pay all copayments by the date when they are due.
- Be honest and open with your physician and report unexpected changes in your condition in a timely fashion.
- Follow healthcare facility rules and regulations affecting patient care and conduct.
- Carry your Humana identification card with you at all times and use it while enrolled in your plan.
- Expedited/Urgent Appeals Form
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