Member Rights & Responsibilities

Members enrolled in State sponsored health benefit plans are afforded a list of rights, and ensuring that members may exercise their rights without fear of retribution is an important issue for CUP.   

 Members have the right to:

• Get understandable notices or have the material explained or interpreted
• Receive timely information about their health plan
• Get courteous, prompt answers from  CUP and the Health Care Authority
• Be treated with respect
• Have their privacy protected by  CUP and CUP network providers
• Get information about all medical services covered by their benefit plan
• Choose their health plan and primary care provider from among available health plans and their contracted networks
• Receive proper medical care, consistent with the services listed in their Member Handbook, without discrimination no matter what their health status or condition, sex, ethnicity, race, marital status, or religion
• Get all medically necessary covered services and supplies listed in the Schedule of Benefits, subject to the applicable limits, exclusions, and cost-sharing
• Take part in decisions about their and their child’s health care, including having a candid discussion about appropriate or medically necessary treatment options, regardless of cost or coverage
• Get medical care without a long delay
• Refuse treatment and be told of the possible results of refusing
• Expect that their and their child’s records and conversations with providers be kept confidential
• Get a second opinion by another CUP provider when they disagree with the initial provider’s recommended treatment plan
• Make a complaint about CUP or CUP providers and receive a timely answer
• File an appeal with CUP  if they are not satisfied with a service request decision
• Change their PCP for a good reason
• Give their consent to treatment or care (Informed Consent)
• Put their health care choices into writing (Advance Directive)
• Have their personal information remain private and confidential according to HIPAA requirements. 

Members have the responsibility to:

• Understand their benefit plan
• Accurately and promptly report changes that may affect their premium or eligibility
• Choose a health plan in their area
• Choose a CUP PCP before receiving services
• Work with CUP to help get any third-party payments for medical care
• Tell CUP about any outside sources of health care coverage or payment
• Tell their PCP, or their child’s PCP, about medical problems and ask questions to be sure they understand
• Decide whether to receive a treatment, procedure, or service
• Get medical services from their or their child’s PCP, except in an emergency or in the case of a referral
• Get a referral from the PCP if required by CUP before going to a specialist
• Pay copayments in full at the time of service (Basic Health)
• Pay their premiums in full by the due date (Basic Health)
• Pay the deductible and coinsurance in full when they are due (Basic Health)
• Not engage in fraud or abuse
• Keep appointments and be on time, or call the provider’s office when late or can’t keep an appointment
• Keep each family member’s medical ID card with the family member at all times
• Notify CUP or PCP within 24 hours, or as soon as is reasonably possible, of any emergency services provided outside CUP’s network
• Use only their CUP PCP to coordinate services for medical needs
• Comply with requests for information, including medical information, by the date requested
• Cooperate with their PCP and referred providers by following recommended procedures or treatment
• Work with CUP and CUP providers to learn how to stay healthy.

Healthy Options, HOBD, CHIP, Foster Care and BH Member Materials:

All Healthy Options, HOBD, CHIP, Foster Care and BH members receive a Member Handbook from the Health Care Authority describing the benefits of the program and other important information about services offered by CHPW and CUP.  To view this information for Basic Health members, please visit.  To view this information for Healthy Options, HOBD, CHIP and Foster Care members, please visit.

 Additionally, Community Health Plan of Washington sends a comprehensive Member Materials packet upon enrollment that includes information on benefits, appeals, Notice of Privacy Practices, and a card to request further information.