Member Rights and Responsibilities

Member Rights

As a member, you have certain rights and responsibilities. Delaware First Health respects your rights. We will not discriminate against you for using your rights. We expect our providers to also respect your rights.

You have the right to:

• Dignity, respect, and privacy from the health plan and our providers.

• Have access to creating and using an advance directive.

• Get information about the organization, its services, its practitioners and providers, and your member rights and responsibilities.

• Be given information about treatment options and care alternatives related to your health condition in a way you will understand.

• Partner with practitioners to make decisions about your care, including the right to refuse treatment.

• Be free from any form of restraint of seclusion by means of coercion, discipline, convenience, or retaliation.

• Request and get a copy of your medical records and be able to request amendments or corrections.

• Amend your data in accordance with HIPAA (Health Insurance Portability and Accountability Act) and State law.

• Exercise your rights without impacting the way Delaware First Health, your providers, or the State of Delaware treats you.

• Get culturally and linguistically appropriate services free of charge.

• Have your personal and medical information kept private.

• File complaints (grievances) or appeals about us or the care we provide.

• Choose a representative, someone to speak on your behalf, to help make care decisions.

• Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.

• Get a copy of Member rights and responsibilities and the right to make recommendations regarding this policy.

• Ask for the Member Handbook and other member information and brochures in other formats, such as other languages, large print, audio CD, or Braille, free of charge. 

Member Responsibilities:

Tell Delaware Health and Social Services (DHSS) if:

• You move out of the State of Delaware or have other address changes.

• You get or have health coverage under another policy, other third party, or if there are changes to the coverage you have on file.

• Tell Delaware First Health when you go to the emergency room (ER) or have been in an auto accident.

• Tell Delaware First Health if your member ID card is lost or stolen.

• Learn about your health status, understand your health, and take part in your treatment goals.

• Talk to your providers about prior authorization of services they recommend.

• Provide Delaware First Health and participating providers with accurate and complete medical information they need in order to provide care.

• Follow the care plans and instructions that you have agreed to with your provider.

• Be aware of cost-sharing responsibilities and make payments that you are responsible for.

• Know Delaware First Health’s procedures, coverage rules, and restrictions the best you can.

• Contact Delaware First Health if you need information or have a question.

• Ask your provider questions to help you understand your treatment. Be actively involved in your treatment. Learn about possible risks, benefits, and costs of treatment alternatives. Make care decisions after you have considered these things. 

• Follow the grievance or appeal process if you have concerns about your care. As noted above, our Member Advocates can help. To reach a Member Advocate, please call Delaware First Health at 1-877-236-1341 (TTY: 711).