Member Rights and Responsibilities

Sunflower members have the following rights:

To get information about Sunflower Health Plan, its services, its practitioners and providers and member rights and responsibilities.
To give their ideas for “Sunflower’s member rights and responsibilities policy.”
To be treated with respect, dignity and privacy.
To get information on care options in a way that they can understand, regardless of cost or coverage.
To participate in decisions about their health care. This includes the right to refuse treatment.
To seek second opinions.
To get help with care coordination from the PCP’s office.
To not be restrained or secluded if doing so is:
- Meant to force them to do something they do not want to do.
- To punish them.
- For someone else’s convenience.
- To get back at them.
To express a concern or appeal about Sunflower or the care it provides. To receive a response in a reasonable period of time.
To receive a copy of their medical records upon request. (One copy is free of charge.) To ask that they be amended or corrected.
To choose their health professional and long-term supports and services providers to the extent possible and appropriate, as per 42 CFR §438.6(m).
To be given health care services as per 42 CFR §§ 438.206 through 438.210.
To get health care services that are similar in amount and scope to those given under Medicaid Fee-For-Service. This includes the right to get health care services that will achieve the purpose for which the services are given.
To get services that are fitting and are not denied or reduced due to:
- Diagnosis
- Type of illness
- Medical condition
To be given information in a manner and format they can understand as defined in the Provider Agreement and the Member Handbook. This includes:
- Enrollment notices
- Informational materials
- Instructional materials
- Treatment options and alternatives
To get free oral interpretation services for all non-English languages.
To be notified that interpretation services are available and how to access them.
To get adequate and timely information on Sunflower’s Physician Incentive Plan upon request.

Sunflower members have the following responsibilities:

To inform Sunflower of the loss or theft of an ID card.
To inform Sunflower, your provider and the State Medicaid program of any change of address or phone number.
To present the Sunflower ID card when using health care services.
To be familiar with Sunflower procedures to the best of their abilities.
To contact Sunflower to get information and have questions answered.
To give providers accurate and complete medical information.
To follow care prescribed by the provider or to let the provider know why treatment cannot be followed, as soon as possible.
To keep appointments and follow-up appointments. To access preventive care services.
To live healthy lifestyles and avoid behaviors known to be harmful.
To understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
To give accurate and complete information needed for care to Sunflower and all their health care and support providers.
To make their primary care provider aware of all other providers who are treating them. This is to ensure communication and coordination in care. This also includes behavioral health providers.
To learn about Sunflower coverage provisions, rules and restrictions.
To ask questions of providers to learn the risks, benefits, and costs of treatment options. To make care decisions after carefully weighing all factors.
To follow Sunflower’s grievance process outlined in the Member Handbook if there is a disagreement with a provider.
To choose a primary care provider (PCP).
To treat providers and staff with dignity and respect.