SEPARACIÓN DE HECHO

Your Rights and Responsibilities as an Anthem Blue Cross Member

As an Anthem Blue Cross Member you have certain rights and responsibilities when receiving your health care. You also have a responsibility to take an active role in your care. As your health care partner, Anthem is committed to making sure your rights are respected while providing your health benefits. That also means giving you access to Anthem network providers and the information you need to make the best decisions for your health and welfare. These are your rights and responsibilities:

You have the right to:

 Speak freely and privately with your doctors and other health providers about all health care options and treatment needed for your condition. This is no matter what the cost or whether it’s covered under your plan.

 Work with your doctors in making choices about your health care.

 Be treated with respect and dignity.

 Expect Anthem to keep your personal health information private. This is as long as it follows state and Federal laws, and Anthem’s privacy policies.

 Get the information you need to help make sure you get the most from your health plan, and share your feedback. This includes information on:

o Anthem company and services

o Anthem network of doctors and other health care providers o Your rights and responsibilities

o The rules of your health care plan o The way your health plan works

 Make a complaint or file an appeal about: o Your health care plan

o Any care you get

o Any covered service or benefit ruling that your health care plan makes

 Say no to any care, for any condition, sickness or disease, without it affecting any care you may get in the future. This includes the right to have your doctor tell you how that may affect your health now and in the future.

 Get all of the most up-to-date information from a doctor or other health care professional about the cause of your illness, your treatment and what may result from it. If you don’t understand certain information, you can choose another person to be with you to help you to understand.

FOR YOUR INFORMATION

You have the responsibility to:

 Read and understand, to the best of your ability, all information about your health benefits or ask for help if you need it.

 Follow all health care plan rules and policies.

 Choose any primary care physician (doctor), also called a PCP, who is in Anthem’s network if your health care plan requires it.

 Treat all doctors, health care providers, and staff with courtesy and respect.

 Keep all scheduled appointments with your health care providers and call their office if you may be late or need to cancel.

 Understand your health problems as well as you can and work with your doctors or other health care providers to make a treatment plan that you all agree on.

 Follow the care plan that you have agreed on with your doctors or health care providers.

 Give Anthem, your doctors and other health care professionals the information needed to help you get the best possible care and all the benefits you are entitled to. This may include information about other health care plans and insurance benefits you have in addition to your coverage with Anthem.

 Let the Customer Service department know if you have any changes to your name, address or family members covered under your plan.

For details about your coverage and benefits, please read your Evidence of Coverage.

Anthem is committed to providing quality benefits and customer service to Members. Benefits and coverage for services provided under the benefit program are governed by the Evidence of Coverage and not by this Member Rights and Responsibilities statement.

If you need more information or would like to contact Anthem, please go to www.anthem.com/ca and select “Customer Support>Contact Us”, or you may call the customer service number on your ID card.

ORGAN DONATION

Each year, organ transplantation saves thousands of lives. The success rate for transplantation is rising, but there are far more potential recipients than donors. More donations are urgently needed.

Organ donation is a singular opportunity to give the gift of life. Anyone age 18 or older and of sound mind can become a donor when he or she dies. Minors can become donors with parental or guardian consent.

Organ and tissue donations may be used for transplants and medical research. Today it is possible to transplant more than 25 different organs and tissues. Today, it is possible to transplant more than 25 different organs and tissues; this can save the lives of as many as eight people and improve the lives of another 50 people. Your decision to become a donor could someday save or prolong the life of someone you know, perhaps even a close friend or family member.

FOR YOUR INFORMATION

If you decide to become a donor, please discuss it with your family. Let your Physician know your intentions as well. You may register as a donor by obtaining a donor card from the Department of Motor Vehicles. Be sure to sign the donor card and keep it with your driver’s license or identification card. In California, you may also register online at:

www.donatelifecalifornia.org/

While organ donation is a deeply personal decision, please consider making this profoundly meaningful and important gift.

ANTHEM BLUE CROSS WEB SITE

Information specific to your benefits and claims history are available by calling Anthem Blue Cross at 1-800-288- 6928 or by logging onto the Anthem Blue Cross web site at www.anthem.com/ca. To access benefit information, claims payment status, benefit maximum status, participating providers or to order an ID card, simply log on to the web site, select “Member,” and click the "Register" button on your first visit to establish a User ID and Password to access the personalized and secure MemberAccess Web site. Once registered, simply click the "Login" button and enter your User ID and Password to access the MemberAccess Web site. Anthem Blue Cross privacy statement can also be viewed on its website. You may also submit a grievance online or print the Plan Grievance Form through the web site.

SPECIAL NOTICE REGARDING REPRODUCTIVE HEALTH CARE SERVICES

Some hospitals and other providers do not provide one or more of the following services that may be covered under your health plan and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor or delivery; infertility treatments, or abortion. You should obtain more information before you select your coverage. Call your respective health care provider, or call Anthem Blue Cross at 1-800-288-6928 to ensure that you can obtain the health care services that you need.

LANGUAGE ASSISTANCE PROGRAM

Anthem Blue Cross introduced its Language Assistance Program to provide certain written translation and oral interpretation services to California Members with limited English proficiency.

The Language Assistance Program makes it possible for the Member to access oral interpretation services and certain written materials vital to understanding his or her health coverage at no additional cost to the Member. Written materials available for translation include grievance and appeal letters, consent forms, claim denial letters, and explanations of benefits. These materials are available in the following languages:

 Spanish

 Chinese

 Vietnamese

 Korean

FOR YOUR INFORMATION