Member rights

Member rights & responsibilities

As a memberA person covered by a health plan., you have a certain rights and responsibilities, such as filing appealsWhen you ask a health insurer to reconsider a decision., subrogation, privacy, nondiscrimination and more.

View your rights

Surprise billing notice

Under the Consolidated Appropriations Act of 2020, you may be protected from surprise or balance billing if you were treated by an out of network provider that you had no choice in using while being treated in an emergency room, a stand-alone emergency center, or in certain instances during a planned procedure at one of our in network facilities.

Summary of Benefits and Coverage

View an easy-to-understand summary about your health plan's benefitsServices your plan covers. Also known as covered services. and coverage.

Report fraud and abuse

Find out how to spot and report fraud such as false claimsA request for payment a doctor or hospital sends to an insurer when you receive care., misrepresentation of services, medically unnecessary services and more.

Report fraud

File an appeal if a claim is denied

Members have a right to file an appeal to request the review of a denial of a claim in whole or in part.

Avoid phone scams

If you receive a call from Health Advantage, we want you to be certain it really is from us. Here's a few ways to be 100 percent certain.

What is subrogation?

Subrogation refers to the legal right of an insurance company — after payment of a loss — to recover monies from the responsible party's insurance carrier.

View subrogation

Personally Identifiable Information (PII) disclosure

Review our privacy notice statement regarding your Personally Identifiable Information.

Claims payment policies & other information

This section provides general information concerning our health insurance plans to aid in the understanding of common policies and procedures.