Rights & Responsibilites

US Family Health Plan supports the President’s Advisory Commission on Consumer Protection. The plan also supports the Health Care Industry’s Consumer Bill of Rights and Responsibilities. This document is available at www.hcqualitycommission.gov.

The plan declares the following rights and responsibilities of our members.

As a member of the plan you have the right to:

  • Change your PCP once every 30 days.
  • Attend all member meetings.
  • Use all additional programs offered by the plan.
  • Submit a letter if a problem concerning your health care was not solved where it occurred. You can also talk with a Patient Advocate or Member Services Representative about the problem.
  • Call and speak with a nurse 24 hours a day by calling 1-800-455-WELL (1-800-455-9355).
  • Have one complete eye exam each year.
  • Have one annual physical each year.
  • Get current information about the doctors and hospitals that participate in the plan.
  • Help your doctor make decisions about your health care.
  • Know how to make appointments and get health care from your PCP during and after office hours.
  • Know how to contact your PCP or his or her on-call support 24 hours a day, every day.

As a member of the plan you have a responsibility to:

  • Pay your enrollment fees on time.
  • Pay co-payments required by the plan.
  • Not use Medicare Part A or B and Medicaid for services covered by the plan.
  • Update your military ID card as needed.
  • Make sure that your DEERS file information and status is correct and current.
  • Notify Member Services at 1-800-67U-SFHP (1-800-678-7347) if there is a change of address and/or phone number or in eligibility for you or a family member.
  • Dis-enroll from the plan if you move outside of the plan service area.
  • Provide the plan with information if you are a member of other health insurance plans.
  • Bring your member card with you when visiting your doctor, pharmacy, or seeking medical treatment.
  • Give your correct information to the provider any time a claim is filed. The needed Information is:
    • Your correct date of birth,
    • Sponsor’s Social Security Number, and
    • The correct spelling of your first and last name.
  • Provide a complete medical history to your physician, including a list of all your medicines (prescription and over-the-counter).
  • Use your plan PCP, plan network specialist (with referral), plan network hospital/facility, and the network pharmacy for routine care.
  • Not use the Military Treatment Facility (MTF), TRICARE or NMOP (National Mail-Order Pharmacy) for routine care.
  • Notify your PCP if possible before:
    • Seeking emergency medical treatment.
    • Seeking care outside of the service area (except when outside of the United States).
  • Notify the plan at 1-800-67U-SFHP (1-800-678-7347) within 24 hours for:
    • Emergency medical treatment.
    • An accident requiring medical attention (motor vehicle accident, workers’ compensation, etc.).
    • Note: Please notify the plan as soon as possible. If you are unable to call immediately, please do so within 24 hours.
    • Transfer your medical record if it is necessary.

Provider Summer Issue

News for US Family Health Plan Providers

Summer 2016

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