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Member Rights and Responsibilities

Your Rights as a Sunflower Member

You have the right to:

  • Receive information about Sunflower, its services, providers and your rights and responsibilities.
  • Share feedback on Sunflower Health Plan's member rights and responsibilities policy.
  • Be treated with dignity, respect and privacy.
  • Understand your care options, regardless of cost or coverage.
  • Participate in decisions about your healthcare, including the right to refuse treatment.
  • Seek second opinions.
  • Get help with care coordination.
  • Be free from restraint or seclusion that is convenient for someone else or is used to punish, coerce or retaliate.
  • File grievances and appeals and receive timely responses.
  • Request and receive a copy of your medical records and ask for corrections. (First copy is free.)
  • Choose your health professional and long-term supports and services providers to the extent possible and appropriate, as per Code of Federal Regulations, Title 42, Section 438.6(m).
  • Be given healthcare services as per Code of Federal Regulations, Title 42, Sections 438.206 through 438.210.
  • Receive services comparable to those under Medicaid Fee-For-Service.
  • Access services without denial or reduction based on diagnosis or condition.
  • Receive information in formats you can understand (e.g., notices, materials, treatment options).
  • Access free oral interpretation services for all non-English languages.
  • Be notified that interpretation services are available and how to access them.
  • Request information about Sunflower Health Plan's Physician Incentive Plan.
  • Exercise your rights without negative consequences.
  • Use any hospital or facility for emergency care.
  • Request a State Fair Hearing.

Your Responsibilities as a Sunflower Member

You are responsible for:

  • Reporting lost or stolen ID cards.
  • Updating Sunflower, your provider and Medicaid with changes to your address or phone number.
  • Presenting your Sunflower ID card when receiving care.
  • Learning about Sunflower Health Plan's procedures and coverage.
  • Contacting Sunflower with questions or for information.
  • Providing accurate and complete medical information to your providers.
  • Following prescribed care or informing your provider if you cannot.
  • Keeping appointments and accessing preventive care.
  • Living a healthy lifestyle and avoiding harmful behaviors.
  • Understanding your health conditions and participating in treatment planning.
  • Informing your PCP about other providers involved in your care, including behavioral health.
  • Learning about Sunflower Health Plan's coverage rules and limits.
  • Asking questions to understand treatment risks, benefits and costs. To make care decisions after carefully weighing all factors.
  • Using the grievance process if you disagree with a provider.
  • Choosing a primary care provider (PCP).
  • Treating providers and staff with respect.