Member Rights & Responsibilities.


Everything you need to know.

Member rights.
As a member of the Plan, you have the right to:

  • Receive information about your coverage and your rights and responsibilities.

  • Receive, upon request, facts about your Plan, including a list of the health 
care services covered and providers available to meet your healthcare needs.

  • Receive courteous service and respect with an appreciation of your dignity 
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 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.

  • 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.

  • 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.

  • Voice complaints and 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.

Your responsibilities.
As a Plan member, you have the responsibility to:

  • 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 amounts at the time of service.

  • 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.

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

  • Comply with the rules outlined in your member material.

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Quality Coverage

St. Luke's has an exceptional network of quality doctors and specialists serving Idaho. We're so glad you're a part of our family.