Member Rights

Please read through the rights and responsibilities that you have as a member of Vibra Health Plan.

As a member of Vibra Health Plan, you have the right to:

  • Have your health information handled in a confidential and private manner in accordance with state and federal law. See notice of privacy practices for a description of how Vibra Health Plan protects your personal health information.
  • Be understood and treated with respect and dignity by Vibra Health Plan personnel, network providers, pharmacies and other healthcare professionals, regardless of race, national origin, religion, physical handicap, or source of payment.
  • Receive information in a language and method you are able to comprehend and understand.
  • Receive information that helps you select a qualified practitioner, including disclosure of their qualifications and presence of malpractice insurance.
  • Designate and/or authorize another party to act on your behalf.
  • Choose an Advance Directive to designate the kind of care you wish to receive should you become unable to express your wishes.
  • Access to physicians, healthcare professionals and healthcare facilities.
  • Know about access to after-hours and 24-hour emergency care.
  • Take part in decisions about your healthcare treatment, including services and care you receive, except when such participation is contraindicated for medical reasons.
  • Candidly discuss with your provider the appropriate and medically necessary treatment options, including alternatives, available to you for your condition(s), regardless of costs and/or benefit coverage.
  • Be informed about, and refuse to participate in, any experimental treatment.
  • Receive, upon request and prior to treatment, a reasonable estimate of charges for medical care.
  • Have coverage decisions and claims processed according to regulatory standards and/or medical policy.
  • Register a complaint and/or appeal concerning your health plan and/or services you received.
  • Ask a question, express a concern or file a complaint without hesitation, and receive a timely response.
  • Have claims paid accurately and promptly.
  • Ask for and receive a copy of your medical records and request a change/correction in any of your medical record, as required by law.
  • Receive, upon request, full information and necessary counseling on the availability of known financial resources for your care.
  • Make recommendations regarding the organization’s rights and responsibilities.

As a member of Vibra Health Plan, you have the responsibility to:

  • Read and understand the information in and the terms of your Evidence of Coverage (EOC) and call Vibra Health Plan’s Member Services if you have questions.
  • Know and understand your benefits.
  • Contact an appropriate healthcare professional when you have a medical need or concern.
  • Show your health plan ID card before receiving healthcare services.
  • Talk openly with your healthcare professional and build a provider-patient relationship built on mutual trust and cooperation.
  • Understand your health issue(s) and/or ask questions of your healthcare provider(s) to obtain the information needed to understand your health issues.
  • Share your health information to support delivery of healthcare services.
  • Develop mutually agreed upon treatment goals with your healthcare provider and follow the established treatment plan and related instructions.
  • Make your required co-payment/co-insurance at the time you receive treatment.
  • Use emergency room services only for injury and illness that, in the judgment of a reasonable person, require immediate treatment to avoid jeopardy to life or health.
  • Keep scheduled appointments and when you are unable to do so, notify your provider in advance if able.
  • Log in to or call Member Services when you have a question about your eligibility, benefits, claims and more.
  • Log in to or call Member Services to verify that your physician or healthcare professional participates in the network.
  • Inform Vibra Health Plan and your doctors if you changed your address.
  • Prevent the illegal use of your Member ID card.
  • Inform your doctor and the plan about any other insurance you have.
  • Conduct yourself in a manner that is respectful of all healthcare providers and staff, as well as other members.
  • Follow healthcare facility rules and regulations affecting your care and conduct.
  • Fulfill your financial obligations related to non-covered services.
  • Be accountable for your own actions if you refuse treatment or you do not follow your healthcare provider recommendations.
  • Inform your provider about any living will, medical power of attorney or Advanced Directives that could affect your care.
  • Call or write within 60 days of service if you wish to request a review of service provided and/or appeal a Vibra Health Plan decision.
  • Live a healthy lifestyle and prevent injury and disease.

Updated October 1, 2021