Fully Insured Member Rights and Responsibilities Statement
(Commercial: Choice, Elect, Premier, MIC, North Dakota product)

To ask that a print version of Fully Insured Member Rights and Responsibilities be mailed to you, call the Customer Service number on your Medica ID card.

Member rights

As a member of Medica, you have the right to:

1. Available and accessible services, including emergency services (defined in your "Certificate of Coverage") 24 hours a day, seven days a week;
2. Information about your health condition, appropriate or medically necessary treatment options and risks, regardless of cost or benefit coverage, so you can make an informed choice about your health care;
3. Participate with providers in decision-making regarding your health care, including the right to refuse treatment recommended to you by Medica or any provider;
4. Be treated with respect and recognition of your dignity, and privacy of your medical and financial records maintained by Medica or any network provider in accordance with existing law;
5. Contact Medica and Minnesota’s Commissioner of Health to file a complaint about issues related to in-network benefits, or Minnesota’s Commissioner of Commerce to file a complaint about issues related to out-of-network benefits (see your "Certificate of Coverage" for additional information). You may begin a legal proceeding if you have a problem with Medica or any provider.
6. Receive information about Medica, its services, its practitioners and providers, and members’ rights and responsibilities.

Member responsibilities

To increase the likelihood of maintaining good health and to ensure that the best quality care is received, it is important that you take an active role in your health care by:

1. Establishing a relationship with a network provider before becoming ill, as this allows for continuity of care;
2. Providing the necessary information to health care professionals needed to determine the appropriate care. This objective is best obtained when you share:
   1. Information about lifestyle practices; and
   2. Personal and family health history;
3. Following the instructions given by those providing health care:
4. Practice self-care by knowing:
   1. How to recognize common health problems and what to do when they occur;
   2. When and where to seek appropriate help; and
   3. How to prevent health problems from recurring;
5. Practice preventive health care by:
   1. Having the appropriate tests, exams and immunizations recommended for your gender and age as described in your "Certificate of Coverage"; and
   2. Engaging in healthy lifestyle choices (such as exercise, proper diet and rest).

Medica has identified some additional rights and responsibilities, including the:

1. Right to privacy.
2. Right to file a complaint or an appeal about Medica, the care you received or a decision regarding your health care. You may do so by contacting Medica Customer Service at 952-945-8000 or 1-800-952-3455. Please refer to your coverage document for more information on your complaint and appeal rights.
3. Right to make recommendations regarding Medica’s members’ rights and responsibilities statement.
4. Responsibility to participate in understanding your health problems, participate in developing mutually agreed-upon treatment goals to the degree possible and to follow the plans that you have agreed on with your health care professional.

Contact your state regulator at any time to file a complaint about Medica or about a doctor or health care provider.

• Call the Minnesota Department of Health at 1-800-657-3916 regarding HMO benefits.
• Call the Minnesota Department of Commerce at 1-800-657-3602 regarding insurance benefits.
• Call the Wisconsin Office of the Commissioner of Insurance at 1-800-236-8517.
• Call the North Dakota Commissioner of Insurance at 1-800-247-0560.