Community First Health Plans Member Rights and Responsibilities
Community First is your partner in managing your health. This partnership is built upon cooperation, with rights and responsibilities for both Community First staff and our members.
Your Rights
As a member you have the right to:
Understand how to access Community First's health care delivery system.
Select one of Community First's primary care physicians within 30 calendar days of
enrollment (for HMO members).
Receive prompt, courteous and appropriate medical treatment.
Access care without physical or communication barriers.
Understand your health problems, the recommended treatment and the reason for the recommendation, alternatives available for treatment and the risks involved and how to care for yourself to maintain optimum health.
Consent to all treatments unless a life- or limb-threatening emergency exists.
Participate in decision-making about your health care and treatment plan; accept or refuse medical, surgical or behavioral health treatments to include establishing advanced
directives as permitted under federal and state laws.
Request a second opinion through Community First.
Have someone not directly involved in your care be present during your examination or
treatment.
Take part in available wellness programs.
Review your medical records, have your medical care and medical records treated with
privacy and confidentiality in accordance with the law and professional medical ethics.
Suggest how we can improve our services to you and other members.
Be treated courteously and in a manner that respects your right to privacy and dignity in a
non-discriminatory manner.
Contact Community First Member Services at (210) 358-6070 or toll-free, 1-800-434-
2347 to file an oral or written complaint or appeal.
Appeal a decision of Community First, related to resolution of a concern, in accordance
with Community First's procedures and in a timely manner.
Have these rights and responsibilities explained to you by Community First's Member Services Department.
Your Responsibilities
As a member, you have the responsibility to:
Take responsibility for personal habits that affect your health.
Learn how Community First works and appropriately use the health plan.
Schedule appointments for routine care; keep scheduled appointments and arrive on
time.
Promptly contact your provider when you are unable to keep an appointment.
Understand when you should or should not go to the emergency room.
Always contact your primary care physician for your non-emergency medical needs (for HMO members).
Establish a continuous and satisfactory relationship with your physician.
Communicate to your physician any concerns that you or your family members may have
about your health or health care.
Give your provider complete and accurate information and help providers obtain your
medical records.
Cooperate with the treatment instructions you and your health care provider agree upon.
Follow Community First's procedures for obtaining care after normal business hours.
Carry your Community First member ID card with you at all times while enrolled.
Pay all applicable service copayments at the time services are rendered.
Pay for services or supplies not covered by Community First.
Contact Community First if there are any changes in family status, address, phone
number, employment status and other insurance coverage.
Respect the dignity of other members and Community First staff and providers.
HMO Members:
Use only Community First's primary care physicians or participating specialists (obtaining
approval from your primary care physician when applicable) and medical facilities, for
urgently needed medical care, except in the case of emergencies or, while away from the
service area or if medically necessary services are not available within Community First's
network.
Advise Community First as soon as possible whenever you receive care from a provider
outside Community First's network, whether inside or outside the service area.
PPO Members:
Use only First Health network physicians or participating specialists and medical facilities,
for urgently needed medical care, except in the case of emergencies.
