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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.