A Healthy CollaborationSM

Understanding Your Rights

Your right to be treated with fairness and respect

You have the right to be treated with dignity, respect and fairness at all times. Community CCRxSM must obey laws against discrimination that protect you from unfair treatment. These laws say that we cannot discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin or any mental or physical disability you may have. If you need help with communication, such as help from a language interpreter, please call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), from 8:00 a.m. to 8:00 p.m., every day.

Your right to the privacy of your medical records and personal health information

There are federal and state laws that protect the privacy of your medical records and personal health information. We keep your personal health information private as protected under these laws. Any personal health information that you provide us when you enroll in this plan is protected. We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care.

The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to review your medical records, and get a copy of your records. There may be a fee charged for making copies. You also have the right to ask us to make additions or corrections to your medical records. If you ask us to do this, we will review your request and determine whether the changes are appropriate. You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about the privacy of your personal information and medical records, please call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), from 8:00 a.m., to 8:00 p.m., everyday.

Your right to get your prescriptions filled within a reasonable period of time

You should get all of your prescriptions filled from a network pharmacy, that is, from pharmacies which contract with Community CCRx. You have the right to go to any of our network pharmacies in order to get your prescriptions filled at the benefit level. You have the right to timely access to your prescriptions. “Timely access” means that you can get your prescriptions filled within a reasonable amount of time.

Your right to know your treatment choices and participate in decisions about your healthcare

You have the right to know about the different Medication Management Treatment Programs we offer, and in which you may participate. You have the right to be told about any risks involved in your care. You have the right to refuse treatment. This includes the right to stop taking your medicine. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.

You have the right to receive a detailed explanation from us if you believe that a network pharmacy has denied coverage for a drug that you believe you are entitled to receive, or care you believe you should continue to receive. In these cases, you must request an initial decision.

Your right to make complaints

You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and “grievances” are two different types of complaints you can make. The type of complaint you make depends on your situation.

If you make a complaint, we must treat you fairly (i.e., not discriminate against you). You have the right to get a summary of information about the appeals and grievances that members have filed against Community CCRx in the past. To get this information, call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), from 8:00 a.m. to 8:00 p.m., everyday.

Your right to get information about your drug coverage and costs

This booklet tells you what you have to pay for prescription drugs as a member of Community CCRx. If you need more information, please call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), from 8:00 a.m. to 8:00 p.m., every day. You have the right to an explanation from us about any bills you may get for drugs not covered by Community CCRx. We must tell you in writing why we will not pay for a certain drug, and how you can file an appeal to ask us to change this decision.

If you believe you may qualify for extra help with drug costs, and are not sure whether you are receiving extra help, you may check the Center for Medicare and Medicaid Services' Best Available Evidence Web site.

Your right to get information about Community CCRx and network pharmacies

You have the right to get information from us about Community CCRx. This includes information about our financial condition, about our network pharmacies and how Community CCRx compares with other Medicare Prescription Drug Plans. To get any of this information, call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), 8:00 a.m. to 8:00 p.m., everyday.

How to get more information about your rights

If you have questions or concerns about your rights and protections, please call Customer Service at 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), 8:00 a.m. to 8:00 p.m., everyday. In addition, the Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week, or you can visit www.medicare.gov to order this booklet or print it directly from your computer.

What can you do if you believe you have been treated unfairly or your rights are not being respected?

  • If you believe you have been treated unfairly or your rights have not been respected, what you should do depends on your situation.

  • If you believe you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know, or call the Office for Civil Rights in your area.

  • For any other concern or problem related to your Medicare rights and protections described in this section, you can call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), 8:00 a.m. to 8:00 p.m., everyday. You can also get help from your State Health Insurance Assistance Program(SHIP).

What are your responsibilities as a member of Community CCRx?

Along with the rights you have as a member of Community CCRx, you also have responsibilities. Your responsibilities include the following:

  • Become familiar with your coverage and the rules you must follow to receive care as a member. If you have any questions, please call Customer Service at: 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), from 8:00 a.m. to 8:00 p.m., every day. *Give your health care provider(s) the information they need to care for you, and follow the treatment plans and instructions given to you. Be sure to ask your health care provider(s) if you have any questions.
  • Pay your plan premiums and any coinsurance/co-payments you may owe for the covered drugs you receive.
  • Let us know if you have any questions, concerns, problems or suggestions. If you do, please call Customer Service at 1-866-684-5353 (TTY/TDD users call 1-866-684-5351), 8:00 a.m. to 8:00 p.m., everyday.

S5803_09P0008_v2 (07/2009) Last Updated: 06/23/2009

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