As a member of Blue Shield of California Promise Health Plan you have important rights and responsibilities.
You have the right to know:
- Know your rights and responsibilities
- Know about our organization, services, doctors, and specialists
- Be informed when your doctor is no longer contracted with Blue Shield of California Promise Health Plan
- Know about all our other caregivers
- Be able to see your medical records and follow the State and Federal laws that apply
- Have an honest talk with your doctor about all treatment choices for your condition, regardless of cost or benefit coverage
You have the right to:
- Always be treated with respect and recognition of your dignity
- Have your privacy kept safe by everyone in our health plan
- Know that we keep all your information private
- You have the right to be in charge of your health care
- Choose your primary care doctor
- Say no to care from your primary care doctor or other caregivers
- Be able to make choices about your health care.
- Make a living will. This is also called an advance directive [link to the Advance directive info below]
- Voice complaints or appeals about Blue Shield of California Promise Health Plan or the care it offers
- File a grievance if you do not receive services in the language you request
You have the right to receive the following range of services:
- Family planning
- Preventive healthcare
- Minor consent services
- Treatment for sexually transmitted diseases (STDs)
- Emergency care outside of our network
- Health care from a Federally Qualified Health Center (FQHC)
- Health care at an Indian Health Center
- A second opinion
- Interpreter services at no cost. This includes services for the hearing-impaired
- Information materials in other formats. For example, you can request large size print upon request
You have the right to suggest changes to our health plan:
- Tell us what you do not like about our health plan;
- Tell us what you do not like about the health care you receive;
- Question our decisions about your health care;
- Tell us what you do not like about our rights and responsibilities policy;
- Ask the Department of Social Services for a fair hearing;
- Ask the Department of Managed Health Care for an Independent Medical Review;
- Choose to leave our health plan.
You have the right to end your Blue Shield of California Promise Health Plan membership (disenroll):
Ending your membership in Blue Shield of California Promise Health Plan may be voluntary (your own choice) or involuntary (not your own choice). For more information on ending your membership, please refer to Chapter 10 of your Member Handbook document.
You might leave our plan because you have decided that you want to leave. There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan.
- Chapter 10, section A of the Member Handbook tells you when you can end your membership in the plan.
- The process for voluntarily ending your membership varies depending on what type of new coverage you are choosing. The Member Handbook Chapter 10, section B tells you how you can end your plan membership.
- There are also limited situations where you do not choose to leave, but we are required to end your membership. The Member Handbook Chapter 10, section F tells you about situations when we must end your membership.
If you are leaving our plan, you must continue to get your medical care through our plan until your membership ends.
We hope you will work with your doctors as partners in your health care.
You have important responsibilities for your health care:
- Complete your Health Risk Assessment within first 45-90 days of your enrollment.
- Work with you Care Navigator to complete your Individual Care Plan
- Share with your doctor what he or she needs to know to treat you
- Learn as much as you can about your health, and work with your doctors to agree on your treatment goals
- Follow the treatment plans to which you and your doctors agree
- Follow what the doctor tells you to do to take good care of yourself
- Follow habits that keep you from getting sick
- Bring your ID card with you when you visit your doctor
- Treat your doctors and other caregivers with respect
- Use the emergency room for emergencies only. Your doctor will give you most of the medical care that you need
- Report healthcare fraud
We want you to understand your health plan:
- Know and follow the rules of your health plan
- Know that laws guide our health plan and the services you get
- Know that we cannot treat you differently because of, age, sex, race, national origin, culture, language needs, sexual orientation, and/or health
Advance Directives right notification
- At enrollment, you have the right to accept or refuse treatment and to complete an advance directive. We will assist you on how to complete the advance directive
- You have the right to file a complaint with the state survey and certification agency
Get more information on Advance Directives.
California Advance Health Care Directive, English (PDF, 824 KB)
California Advance Health Care Directive, Spanish (PDF, 1 MB)
California Advance Health Care Directive, Chinese (PDF, 5.4 MB)
California Advance Health Care Directive, Bilingual English/Spanish (PDF, 2 MB)
California Advance Health Care Directive, Bilingual English/Vietnamese (PDF, 2.4 MB)