Member rights and responsibilities

For the most up to date Health Share member rights and responsibilities, check your member handbook.

Health Share member rights

Health Share members have the following rights:

  • Be treated with dignity, respect and privacy
  • Be treated by participating providers the same as other people seeking health care benefits to which they are entitled, and to be encouraged to work with your care team, including providers and community resources appropriate to your needs
  • To be free from discrimination in receiving benefits and services to which you are entitled
  • To receive equal access for both males and females under 18 years of age to appropriate treatment, services and facilities. This includes homeless youth and those in gangs, as required by ORS 417.270
  • Choose a Primary Care Provider (PCP), Primary Care Dentist (PCD), mental health provider or service site, and to make changes to these as permitted in Health Share’s administrative policies
  • Get behavioral health or family planning services without a referral from a PCP or other participating provider
  • Have a friend, family member, or advocate with you during appointments and other times as needed within clinical guidelines
  • Be actively involved in the development of your treatment plan; to talk honestly with your  provider about appropriate or medically necessary treatment choices for your conditions, regardless of the cost or benefit coverage
  • Be told information about your condition and covered and non-covered services in a way that you can understand, to allow an informed decision about proposed treatments
  • Consent to treatment or refuse services, and be told the consequences of that decision, except for court-ordered services
  • Receive written materials describing rights, responsibilities, benefits available, how to access services, and what to do in an emergency
  • Have written materials explained in a manner that is understandable to you, including the coordinated care approach and how to get services in the coordinated health care system
  • Receive services and support in a language you understand, and in a way that respects your culture, as close to home as possible
  • To choose providers, if available within the network, that are in non-traditional settings and accessible to families, diverse communities, and underserved populations
  • Receive care coordination and transition planning from Health Share in a language
  • you understand and in a way that respects your culture, to ensure that community-based care is provided in as natural and integrated an environment as possible, and in a way that keeps you out of the hospital
  • Receive necessary and reasonable services to diagnose your condition
  • Receive integrated, person-centered care and services that provide choice, independence and dignity, and that meet generally accepted standards of medically appropriate practice
  • Receive the level of service that you expect and deserve, as approved by your providers
  • Have a consistent and stable relationship with a care team that is responsible for comprehensive care management
  • Receive assistance using the health care delivery system and accessing community and social support services and statewide resources, including but not limited to certified or qualified health care interpreters, advocates, community health workers, peer wellness specialists and personal health navigators who are part of your care team. This is to provide cultural and language assistance appropriate to your need to participate in making decisions about your care and services
  • Obtain covered preventive services
  • Have access to urgent and emergency services 24 hours a day, 7 days a week without prior authorization;
  • Receive a referral to specialty providers for medically appropriate covered services, following the CCO’s referral policy
  • Have a clinical record that documents conditions, services received, and referrals made
  • To have access to your own clinical record unless restricted by statute, and to receive a copy and have corrections made to your health information
  • To know that information in your medical record is confidential, with exceptions determined by law; to receive a notice that tells you how your health information may be used and shared; to decide if you want to give your permission before your health information can be used or shared for certain purposes and to get a report on when and why your health information was shared for certain purposes
  • Transfer of a copy of the clinical record to another provider
  • Write a statement of wishes for treatment, including the right to accept or refuse medical, surgical, dental or behavioral health treatment
  • Write advance directives and powers of attorney for health care established under ORS 127
  • To be free from any form of restraint or seclusion (isolation) that is not medically necessary or is used by staff to bully or punish you. Staff may not restrain or isolate you for the staff’s convenience. You have the right to report violations to Health Share and to the Oregon Health Plan – see the Complaints section in your member handbook.
  • Receive written notices before denials or changes in benefits or service levels if a notice is required by federal or state regulations
  • Be able to make a complaint or appeal with the health plan or Health Share and receive a response
  • Request a contested case hearing
  • Receive qualified health care interpreter services; and to have information provided in a way that works for you. For example, you can get it in other languages, in Braille, in large print or other format such as electronic. If you have a disability, we must give you information about the plan’s benefits in a way that is best for you
  • Receive notice of an appointment cancellation in a timely manner
  • The right to obtain a second opinion
  • To receive information about Health Share, our providers and services
  • To make recommendations about Health Share’s member rights and responsibilities policy
  • To request and receive information on the structure and operation of Health Share or any physician incentive plan
  • To know that if you believe your rights are being denied or your health information isn’t being protected, you can do either or both of the following:
    • File a complaint with your provider or health insurer.
    • File a complaint with the Client Services Unit for the Oregon Health Plan.
    • Help choose a PCP or clinic, a primary care dentist (PCD), and a Primary Mental Health Provider if needed
    • Treat Health Share staff, providers, and clinic staff members with respect
    • Be on time for appointments, and call in advance to cancel if unable to keep the appointment or if you expect to be late
    • Seek periodic health exams and preventive services from your PCP, PCD or clinic
    • Use your PCP or clinic for diagnostic and other care except in an emergency
    • Obtain a referral to a specialist from your PCP or clinic before seeking care from a specialist unless self-referral to the specialist is allowed
    • Use urgent and emergency services appropriately, and tell your PCP or clinic within 3 days of using emergency services
    • Give accurate information that may be included in the clinical record
    • Help the provider or clinic obtain clinical records from other providers which may include signing an authorization for release of information
    • Ask questions about conditions, treatments, and other issues related to your care that you do not understand
    • Use information provided by Health Share providers or care teams to make informed
    • decisions about a treatment before you receive it
    • Help your providers make a treatment plan
    • Follow treatment plans as agreed and take active part in your health care
    • Tell your providers that your health care is covered under the OHP before you receive services and, if requested, show the provider your Oregon Health ID card
    • Call OHP Customer Service to tell them of a change of address or phone number
    • Call Health Share Customer Service and OHP Customer Service if you become pregnant, and when the baby is born
    • Tell OHP Customer Service if any family members move in or out of the household
    • Call Health Share Customer Service if there is any other insurance available
    • Assist your health plan in pursuing any third party resources available, and reimburse the health plan the amount of benefits it paid for an injury if you receive a settlement for that injury
    • Bring issues, complaints and grievances to the attention of the health plan or Health Share
    • Stat. Auth.: ORS 414.032, 414.615, 414.625, 414.635, 414.651
    • Stats. Implemented: ORS 414.610 – 685 OL 2011, Ch 602 Sec. 13, 14, 16, 17, 62, 64 (2), 65, HB 3650
    • Hist.: DDMAP 16-2012(Temp), f. & cert. ef. 3-26-12 thru 9-21-12; DDMAP 37-2012, f. & cert. ef. 8-1-12

Health Share member responsibilities

Health Share members have the following responsibilities:

Health Share of Oregon receives money from the Federal government to provide you the best health services and coverage possible. It is against the Federal Law for Health Share of Oregon to discriminate against you based on:

  • Age
  • Color
  • Country of Origin
  • Disability
  • Gender Identity or Gender Expression
  • Genetic Information
  • Protected Veteran Status
  • Race
  • Religion
  • Sex
  • Sexual Orientation
  • Your participation in any program or activity through Health Share; or any programs associated with Health Share
  • You receiving any services or benefits from any programs or activities from Health Share; or any programs associated with Health Share