Receive information about your coverage and your rights and responsibilities.

Receive, upon request, information about the plan, including covered services, coverage rules, participating providers and pharmacies, provider qualifications, and other information needed to make informed health care decisions.

Receive courteous service and respect for your dignity, values, and cultural sensitivities,
and protection of your privacy from St. Luke’s Health Plan.

Receive courteous service and respect from St. Luke’s Health Plan’s network providers.

Receive the reasons why St. Luke’s Health Plan denied a request for treatment 
or health care service, and the rules used to reach those results.

Receive, upon request, details on the rules used by St. Luke’s Health Plan to 
decide whether a procedure, treatment, site, equipment, drug, or device needs prior approval.

Receive, upon request, a copy of St. Luke’s Health Plan list of covered prescription drugs. You can also request updates about when a drug may become covered.

Receive information in a manner that is accessible and appropriate to your needs, including interpreter services, auxiliary aids, and information in alternative formats when available and required by law.

Receive clear and correct facts to help you make your own health care choices.

Play an active part in your health care and discuss treatment options with your doctor without regard to cost or benefit coverage.

Be informed by your provider about your health so you may make thoughtful decisions before you receive treatment.

Participate with practitioners in making decisions about your health care.

Be informed of all treatment options available for your condition, including the risks and benefits of those options, regardless of whether the treatment is covered by the Plan.

Accept or refuse recommended treatment and be informed of the potential consequences of that decision.

Make advance directives and provide instructions regarding your health care should you become unable to make decisions for yourself.

Have reasonable access to appropriate medical services regardless of your race, religion, nationality, disability, sex, or sexual orientation, and 24- hour access to urgent and emergency care.

Receive covered services and prescription drugs within a reasonable timeframe consistent with your medical needs.

Have all claims paid accurately and in a timely manner.

Expect that St. Luke’s Health Plan will take measures to keep your health information private and protect your health care records.

Review, obtain copies of, and request amendments to your health information as permitted by applicable law.

Voice complaints and file grievances, expect a fair and quick appeals process for addressing any concerns you may have with St. Luke’s Health Plan.

Make recommendations regarding St. Luke’s Health Plan’s member rights and responsibilities policies.

Receive information regarding your rights to voluntarily disenroll from the Plan, request a special enrollment period when eligible, and obtain information about other coverage options available to you.

Receive notice when the Plan intends to terminate your coverage or disenroll you, including information regarding your appeal rights, if applicable.

Read all plan materials carefully as soon as you enroll and ask questions when necessary.

Contact St. Luke’s Health Plan whenever you have a question or if St. Luke’s Health Plan material or correspondence is unclear.

Use St. Luke’s Health Plan providers when available, carry your ID Card, and pay copay/coinsurance, premiums, and other applicable member cost-sharing amounts when due.

Follow the course of treatment prescribed by your provider. If you choose not to comply, advise your provider.

Provide St. Luke’s Health Plan and your doctors with complete information about your illness, accident, or health care issues, which may be needed to provide care.

Ask questions and make sure you understand the explanation and instructions you are given.

Understand your health problems and participate in developing mutually agreed upon treatment goals to the degree possible.

Make appointments for non-emergency medical care. Keep scheduled appointments or give adequate notice of cancellation.

Play an active part in your health care.

Inform St. Luke’s Health Plan if you have other health insurance or prescription drug coverage.

Present your Plan identification card whenever you receive health care services or prescription drugs.

Notify St. Luke’s Health Plan of changes to your address, telephone number, or other contact information.

Be polite to network providers, their staff, and St. Luke’s Health Plan employees.

Comply with the rules outlined in your member material.

Notify the Plan promptly of circumstances that may affect your eligibility or enrollment status, including a permanent move outside the Plan's service area or loss of eligibility for coverage.

Review enrollment and coverage information provided by the Plan and report any errors or discrepancies as soon as possible.