Member Rights and Responsibilities

University of Michigan Health Plan Commercial Membership Rights

Enrollment with University of Michigan Health Plan (UM Health Plan) entitles members to the right to:

1. Receive information about your rights and responsibilities as a member in terms you can understand.
2. Have access to culturally and linguistically appropriate language interpretation services free of charge.
3. Always be treated with respect and recognition of your dignity and right to privacy.
4. Expect privacy of your personal health information (PHI).
5. Choose and change a primary care provider (PCP) from a list of network physicians or practitioners.
6. Information on all treatment options that you may have in terms you can understand so that you can give informed consent before treatment begins.
7. Refuse treatment to the extent permitted by law and be informed of the consequences of your refusal.
8. Openly discuss appropriate or medically necessary treatment options regardless of cost or benefit coverage.
9. Participate with providers in making decisions involving your health care.
10. Voice concerns or complaints about your health care by contacting Customer Service or submitting a formal, written grievance through UM Health Plan’s appeals process.
11. Be given information about UM Health Plan, its services, and the health care providers in our network, including their qualifications.
12. Make suggestions regarding UM Health Plan’s member rights and responsibilities policies.
13. Receive covered benefits consistent with your plan summary and state and federal regulations.

University of Michigan Health Plan Commercial Membership Responsibilities:

As a UM Health Plan member, you have the responsibility to:

1. Select or be assigned a primary care provider (PCP) from UM Health Plan’s list of network health care providers if required by your plan and notify UM Health Plan when you have made a change.
2. Be aware that all hospitalizations must be approved in advance by UM Health Plan, except in emergencies or for urgently needed health services.
3. Use emergency department services only for the treatment of a serious or life-threatening medical condition.
4. Always present your member ID card to health care providers each time you receive health services, never let another person use it, report its loss or theft to UM Health Plan, and destroy any old cards.
5. Be considerate and courteous to UM Health Plan associates, your providers, their staff, and other patients.
6. Notify UM Health Plan of any changes in address, eligible family members, marital status, or if you acquire other health care coverage.
7. Provide complete and accurate information (to the extent possible) that UM Health Plan and health care providers need in order to provide care.
8. Understand your health problems and develop treatment goals you agree on with your health care provider.
9. Follow the plans and instructions for care that you agree on with your health care provider.
10. Understand what services have cost shares to you and to pay them directly to the health care provider who gives you care.
11. Read your UM Health Plan member materials and become familiar with your provider network.
12. Follow your health plan benefits and UM Health Plan policies and procedures.
13. Report suspected health care fraud or wrongdoing to UM Health Plan by contacting Customer Service.

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