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Medicaid Open Enrollment begins October 1st. To join Delaware First Health, call the Health Benefits Manager at 1-800-996-9969
Medicaid Open Enrollment begins October 1st. To join Delaware First Health, call the Health Benefits Manager at 1-800-996-9969

Member Rights and Responsibilities

Member Rights

As a member you have certain rights. Delaware First Health wants to respect your rights and we expect our providers to respect your rights. Your rights are:

  • A right to receive information about Delaware First Health, its services, providers and member rights and responsibilities.
  • A right to give your ideas for “Delaware First Health’s member rights and responsibilities policy.”
  • A right to be treated with respect, dignity and privacy.
  • A right to get information on care options in a way that you can understand, regardless of cost or coverage.
  • A right to participate in decisions about your health care, which includes the right to refuse treatment.
  • A right to seek second opinions.
  • A right to get help with care management from the PCP’s office.
  • A right to express a concern or appeal about Delaware First Health or the care you receive, and to receive a response in a reasonable period of time.
  • A right to receive a copy of certain of your health plan records upon request (one copy is free of charge) and to ask that your records be amended or corrected where necessary.
  • A right to choose your health professionals and long- term supports and services providers to the extent possible and appropriate, as per 42 CFR §438.6(m).
  • A right to be given health care services, as per 42 CFR §§ 438.206 through 438.210.
  • A right 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.
  • A right to get services that are fitting and are not denied or reduced due to:
    • Diagnosis
    • Type of illness
    • Medical condition
  • A right to be given information in a manner and format you can understand. This includes:
    • Enrollment notices
    • Informational materials
    • Instructional materials
  • A right to treatment options and alternatives
  • A right to get free oral interpretation services for all non- English languages.
  • A right to be notified that interpretation services are available and how to access them.
  • A right to get adequate and timely information on Delaware First Health’s Physician Incentive Plan upon request.

 

We are committed to keeping your race, ethnicity, and language (REL), and sexual orientation and gender identity (SOGI) information confidential. We use some of the following methods to protect your information:

  • Maintaining paper documents in locked file cabinets
  • Requiring that all electronic information remain on physically secure media
  • Maintaining your electronic information in password-protected files

We may use or disclose your REL and SOGI information to perform our operations. These activities may include:

  • Designing intervention programs
  • Designing and directing outreach materials
  • Informing health care practitioners and providers about your language needs
  • Assessing health care disparities

We will never use your REL and SOGI information for underwriting, rate setting or benefit determinations or disclose your REL or SOGI information to unauthorized individuals.

 

Member Responsibilities

As a member you have certain responsibilities. Treatment can work better if you do these things. Your responsibilities are:

  • Notify Delaware Medicaid if:
    • Your family size changes,
    • You move out of the state or have other address changes, or
    • You get or have health coverage under another policy, other third party, or there are changes to that coverage
  • To inform Delaware First Health of the loss or theft of an ID card.
  • To inform Delaware First Health, your providers and the State Medicaid program of any change of address or phone number.
  • To present the Delaware First Health ID card when using health care services.
  • To be familiar with Delaware First Health procedures to the best of your abilities.
  • To contact Delaware First Health to get information and have questions answered.
  • To give Delaware First Health and participating providers accurate and complete medical information they need in order to provide care.
  • 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 your health problems and participate in developing treatment goals with your doctor and other providers, to the degree possible.
  • To make your Primary Care Provider (PCP) aware of all other providers who are treating you, including behavioral health providers. (This is to ensure communication and coordination in care.)
  • To learn about Delaware First Health coverage provisions, rules and restrictions.
  • To ask questions of your providers to learn the risks, benefits, and costs of treatment options and to make care decisions after carefully weighing all factors.
  • To follow Delaware First Health’s grievance process outlined in the Member Handbook if you have a disagreement with a provider.
  • To choose a PCP.
  • To treat providers and staff with dignity and respect.
  • Delaware First Health (DFH) promotes the delivery of services in a culturally competent manner to all Health Plan members, including those with limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or gender identity.