Medica recognizes the importance of a three-way relationship among members, their providers and their health plan. Medica believes that education about health care responsibilities is important because it helps members get the greatest benefit from their health plan. Therefore, Medica is sharing the following statements with Medica’s physician and provider community in order to improve the health of the members Medica serves:
Unless otherwise noted, the term “member” as used throughout these statements refers to both fully insured members, and selfinsured and State Public Program enrollees.
Medica members have certain legal rights and responsibilities as identified below:
- Available and accessible services, including emergency services (defined in their “Certificate of Coverage”) 24 hours a day, seven days a week.
- Information about their health condition, appropriate or medically necessary treatment options and risks, regardless of cost or benefit coverage, so the member can make an informed choice about their health care.
- Participate with providers in decision-making regarding their health care, including the right to refuse treatment recommended by Medica or any provider.
- Be treated with respect and recognition of their dignity, and privacy of the member’s medical and financial records maintained by Medica or any network provider in accordance with existing law.
- Contact Medica and the applicable state regulator to file a complaint about issues related to benefits, (the “Certificate of Coverage” provides additional information). The member may begin a legal proceeding if they have a problem with Medica or any provider.
- Receive information about Medica, its services, its practitioners and providers, and members’ rights and responsibilities.
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To increase the likelihood of maintaining good health and to ensure that the best quality care is received, it is important that the member take an active role in their health care by:
- Establishing a relationship with a network provider before becoming ill, as this allows for continuity of care;
- Providing the necessary information to health care professionals needed to determine the appropriate care. This objective is best obtained when the member does share:
a. Information about lifestyle practices; and
b. Personal and family health history;
- Following the instructions given by those providing health care.
- Practicing self-care by knowing:
a. How to recognize common health problems and what to do when they occur;
b. When and where to seek appropriate help; and
c. How to prevent health problems from recurring;
- Practicing preventive health care by:
a. Having the appropriate tests, exams and immunizations recommended for your gender and age as described in your
“Certificate of Coverage”; and
b. Engaging in healthy lifestyle choices (such as exercise, proper diet and rest).
Medica has identified some additional rights and responsibilities for members, including the:
- Right to privacy.
- Right to file a complaint or an appeal about Medica, the care they received or a decision regarding their health care. Their coverage document has more information on their complaint and appeal rights.
- Right to make recommendations regarding Medica’s members’ rights and responsibilities statement.
- Responsibility to participate in understanding their health problems, participate in developing mutually agreed-upon treatment goals to the degree possible and to follow the plans that they have agreed on with their health care professional.
Medica’s commercial members may contact their state regulator at any time to file a complaint about Medica, a doctor or a health care provider by calling:
- The Minnesota Department of Health at (800) 657-3916 regarding HMO benefits.
- The Minnesota Department of Commerce at (651) 296-2488 or (800) 657-3602 regarding insurance benefits and HMO out-of-network benefits.
- The Wisconsin Office of the Commissioner of Insurance at (608) 266-0103 or (800) 236-8517.
- The North Dakota Commissioner of Insurance at (800) 247-0560.
- The South Dakota Division of Insurance at (605) 773-3563.
Members may contact the Minnesota Department of Human Services at (651) 431-2660 or (800) 657-3729 at any time to file a grievance or an appeal about Medica, a doctor or a health care provider.
Members may contact the Minnesota Department of Commerce at (651) 296-2488 or (800) 657-3602 at any time to file a complaint or an appeal about Medica, a doctor or a health care provider.
Members may contact the Minnesota Department of Health at (800) 657-3916 at any time to file a complaint or an appeal about Medica, a doctor or a health care provider.
Members may contact the Minnesota Department of Commerce at (651) 296-2488 or (800) 657-3602 at any time to file a complaint or an appeal about Medica, a doctor or a health care provider.
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Members of Medica Individual Plans also have the right to:
- A grace period of 31 days for payment of each premium due after your first premium payment. Your coverage will continue during this grace period.
Members of Medica Choice Care or Medica MinnesotaCare also have the right to:
- A clear explanation of covered nursing home and home care benefits.
- Give written instructions about your medical care. This is called a “living will.”
- Join with health care providers in decision making regarding their health care.
- Choose where you will get family planning services.
- Get a second opinion for medical, mental health and chemical dependency services.
- Be free of restraints or seclusion used as a means of coercion, discipline, convenience, or retaliation during their health care visits.
- Request and receive a copy of their medical records. They also have the right to ask to correct the records.
- File an appeal with Medica or the Minnesota Department of Human Services (also referred to as “the State”). They may file an appeal with the State before or at any time during Medica’s appeal process. They do not have to file an appeal with Medica before they appeal to the State.
Members of Medica Prime Solution or Medica Select Solution also have the right to:
- Voluntarily disenroll from Medica Prime Solution or Medica Select Solution and not be requested or encouraged to disenroll except in circumstances specified in federal law.
- A grace period of 30 days for payment of each premium due after your first premium payment. Your coverage will continue during this grace period.
Member of Medica's Medicare products also have the right to:
- A clear description of nursing home and home care benefits covered by Medica.
- Use an "advance directive".
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It is the policy of Medica to treat all persons alike, without distinctions based on race, color, creed, religion, national origin, gender, marital status, status with regard to public assistance, disability, sexual orientation, age or any other classification protected by law. If you have questions about this policy, contact Member Service.
- Medica Choice, Elect and Premier, Medica Insurance Company and other commercial products, call (952) 945-8000 or (800) 952-3455. For members with a hearing impairment, please call the National Relay Center at (800) 855-2880 and ask for (800) 234-8755.
- Medica Select Solution, Medica Dual Solution, Medica Prime Solution and other Medicare products, call (952) 992-2300 or (800) 234-8755. For members with a hearing impairment, please call the National Relay Center at (800) 855-2880 and ask for (800) 234-8755.
- Medica Choice Care and MinnesotaCare, and other state public programs, call (952) 992-2322 or (800) 373-8355. For members with a hearing impairment, please call the National Relay Center at (800) 855-2880 and ask for (800) 234-8755.
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Medica and any participating provider shall maintain the confidentiality of all information regarding members in accordance with all applicable state and federal statutes and regulations.
In addition, each participating provider shall maintain the confidentiality of all quality assessment, utilization review information, and the terms of any contractual arrangement, including the amounts reimbursed by Medica to the participating provider, and shall not disclose any such information to any third party or any division, business unit or affiliate and shall cause each participating provider to use his or her best efforts to protect such information from an unauthorized disclosure by any person and shall not use or allow any person to use any such information in any way that is detrimental to Medica or that may cause competitive disadvantage to Medica.
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