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Member Rights & Responsibilities

As a member of a CareFirst Medicare Advantage plan, you have the right to:​
  • Receive information about the health plan you have selected, its services, practitioners and your rights and responsibilities in a way that works for you (in languages other than English, in Braille and, in large print).
  • Be treated with fairness and in a manner reflecting respect for your privacy and dignity as a person.
  • Not be discriminated against because of age, disability, race, color, religion, sex, or national origin.
  • Receive timely access to your covered services and drugs.
  • Receive from your providers, an explanation of your complete medical condition, recommended treatment, risk of treatment, expected results and reasonable medical treatment alternatives. The information should be provided in terms and a language you understand.
  • Participate with providers in the decision-making process regarding your health care and treatment decisions.
  • Receive sufficient information to enable you to give informed consent before the initiation of any procedure and/or treatment.
  • Refuse treatment to the extent permitted by law and to be made aware of the potential medical consequences of such action.
  • Expect that all communications and records pertaining to your health care will be treated as confidential, and that no such records will be released without your authorization. Confidentiality, privacy and security of your medical records and other information as well as the right to access your medical records will be in accordance with federal and state laws. Your signature on the enrollment form authorizes any provider who provides services to you to release to the plan any information or medical records related to those services.
  • Select your own personal physician from among our network of primary care physicians, as appropriate, and to expect that physician to provide quality care, and to arrange for and coordinate all care you receive.
  • Reasonable access to necessary medical services.
  • Express a complaint regarding the Health Plan for the care provided to you, and to expect an answer within a reasonable period.
  • Call the health plan whenever you have a question about the plan or your benefits.
  • You have the right to make recommendations regarding the organization’s member rights and responsibilities policy.
  • You have the right to make complaints and appeals about the organization or the care it provides without discrimination and expect problems to be fairly examined and appropriately addressed.
As a member of a CareFirst Medicare Advantage plan, you have the responsibility to:​
  • Review all membership and benefit materials carefully and to follow the guidelines pertaining to your specific plan. Obtain prior authorization for certain services, if required by your benefit plan. You are subject to all of the terms, conditions, limitations and exclusions of your benefit plan, as described by your membership and benefit documents.
  • Always seek care through your family physician, if applicable.
  • Obtain services from In-network providers, if required by the terms of your benefit plan. Before receiving services from a specialist, hospital, or other provider, verify they accept the terms and payment conditions of CareFirst Medicare Advantage. Any additional charges from non-participating providers are your responsibility.
  • Always identify yourself as a CareFirst Medicare Advantage member when calling for an appointment and obtaining health care services. Present your health plan identification (ID) card every time you obtain services.
  • Keep scheduled appointments or, if necessary, call to cancel appointments as early as possible. Remember the provider may bill you if you fail to keep a scheduled appointment.
  • Inform us of any additional health insurance you or your family may have so that payments can be properly coordinated between us and the other insurer.
  • Follow instructions and guidelines given by those providing health care services.
  • Provide, to the extent possible, information needed by professional staff in order to provide care to you. 
  • Know how to recognize an urgent care condition versus a medical emergency and what to do if one should occur.
  • Pay member copayments, deductibles, and coinsurance to your provider, if applicable, at the time of service or care.
  • You have a responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.