Member Rights and Responsibilities

We want you to understand your rights and responsibilities as a member of Jai Medical Systems.

We want you to understand your rights and responsibilities as a member of Jai Medical Systems.

Please review your member rights and responsibilities, which are detailed below.

Member Rights

As a member of Jai Medical Systems Managed Care Organization, you have the right:

  • To be treated with respect and recognition of your dignity and the need for privacy at all times. (Please see the Privacy Notice posted in your PCP’s office or you may request a copy from the Customer Service Department.)
  • To receive information, including information on treatment options and alternatives in a manner you can understand.
  • To be assisted in a prompt, courteous, and a responsible manner, regardless of your gender, race, age, religion, national origin, physical or mental disability, or type of illness or condition.
  • To receive interpreter services if you do not speak English or are hearing impaired.
  • To have access to your medical records in accordance with applicable federal and state laws.
  • To request and receive a copy of your medical records and request that they be amended and corrected as allowed.
  • To voice complaints about Jai Medical Systems Managed Care Organization or the care provided. You also have the right to offer suggestions for changes in policies and procedures, including the policy regarding members’ rights and responsibilities.
  • To receive a second opinion from another doctor in Jai Medical Systems Managed Care Organization if you don’t agree with your doctor’s opinion about the services that you need. Contact Jai Medical Systems Managed Care Organization at 1-888-JAI-1999 for help with this.
  • To file appeals and grievances with Jai Medical Systems Managed Care Organization.
  • To exercise your rights and to know that the exercise of those rights will not adversely affect the way that Jai Medical Systems Managed Care Organization or our providers treat you.
  • To use the enrollee complaint resolution process if dissatisfied about the organization or care provided, and to receive a fair and prompt response, and to file a grievance and appeal if not satisfied.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
  • To file appeals and grievances with the State.
  • To State Fair Hearings.
  • To request that ongoing benefits be continued during an appeal or state fair hearing however, you may have to pay for the continued benefits if our decision is upheld in the appeal or hearing.
  • To know that you and your provider cannot be penalized for making a complaint or grievance.
  • To participate in decisions regarding your health care, including the right to refuse treatment.
  • To refuse treatment, but to be told the consequences of refusing treatment or not complying with the treatment prescribed by your provider.
  • To receive other information about Jai Medical Systems Managed Care Organization, such as how we are managed. You may request this information by calling 1-888-JAI-1999.
  • To receive care from competent health care providers and to expect Jai Medical Systems Managed Care Organization to demand full competence from its clinical and administrative staff.
  • To be free from receiving bills from providers for medically necessary services that were authorized or covered by Jai Medical Systems Managed Care Organization.
  • To receive and review information about medically acceptable alternatives of treatment along with their potential hazards and reasonable expectations of each alternative.   You have the right to openly discuss appropriate or medically necessary treatment options, regardless of cost or benefit coverage.
  • To complete an advance directive, living will, or durable medical power of attorney form before each hospitalization, specifying your wishes about the use of extraordinary life saving measures.

Member Responsibilities

As a member of Jai Medical Systems Managed Care Organization, you have the responsibility:

  • To be considerate and respectful, and not engage in the use of foul language, threats, or physical actions that may endanger the lives, health, or social well being of Jai Medical Systems Managed Care Organization’s medical providers, administrative staff, or other members.
  • To support the member/provider relationship by being courteous and making every attempt to keep scheduled appointments or to notify the provider’s office at least 24 hours in advance of a cancellation.
  • To notify your primary care provider as soon as possible after you receive emergency treatment.
  • To contact your primary care provider before you seek non-emergency health care from other providers or places.
  • To be patient, if delays occur beyond the control of the provider causing a longer waiting time to be seen.
  • To carry your Jai Medical Systems Managed Care Organization membership card at all times and report lost cards immediately.
  • To read the Member Handbook and contact the Customer Service Department if you have any questions or need help.
  • To provide, whenever possible, accurate medical information needed by Jai Medical Systems and the provider who is providing health care.
  • To express opinions, concerns, or complaints regarding health care in a constructive manner.
  • To follow instructions and guidelines given by those providing health care services.
  • To present true and accurate administrative information and update Jai Medical Systems Managed Care Organization with any changes in family status and address, as well as the existence of any other health insurance available to you.
  • To present true and accurate medical information to the PCP chosen by, or assigned to you, including any public health problems that you may have.
  • To not demand treatments that have been determined not to be acceptable medical practices.
  • To not engage in illegal acts, such as forging or falsifying a provider’s name on documents requiring a provider’s signature.
  • To understand your health problems and to work with your provider to create medically appropriate treatment goals that you will follow.