June 11, 2025
As a participating provider, it’s important that you are aware of our members’ rights and responsibilities. A summary is provided below. Additional information can be found in the members’ benefit booklet.
Membership rights include the right to:
- Receive information about the organization, its services, its practitioners and providers, and member’s rights and responsibilities
- Make recommendations regarding the organization’s member rights and responsibilities policy
Membership responsibilities include the responsibility to:
- Provide, to the extent possible, information that their health benefit plan and practitioner/provider need in order to provide care
Communication rights include the right to:
- Participate with practitioners in making decisions about their health care
- Be treated with respect and recognition of their dignity and their right to privacy
- A candid discussion of appropriate or medically necessary treatment options for their condition, regardless of cost or benefit coverage
- Voice complaints or appeals about the organization or the care it provides
Communication responsibilities include the responsibility to:
- Follow the plans and instructions for care that the member has agreed to with their practitioner
- Understand their health problems and participate in the development of mutually agreed upon treatment goals, to the degree possible
Federal Employee Program® members: In addition to the details provided above, visit fepblue.org for more information about our FEP® members and their rights and responsibilities.