Member Rights & Responsibilities

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

• Know the names and qualifications of healthcare professionals involved in your medical treatment.
• Know what services are covered, including non-covered services, limitations, and exclusions.
• Obtain information about the Plan, its services, participating providers, and procedures used to make coverage decisions.
• Obtain information about applicable fees, copayments, and payment policies.
• Receive current information about participating healthcare professionals, hospitals, and other providers, including provider malpractice insurance information, upon request.
• Receive instructions on how to file a complaint or appeal with the Plan. See FEHB Plan brochure for details.
• Voice complaints, grievances, or appeals and do so without fear of retaliation or adverse treatment.
• Receive instructions on how to submit a claim. Find instructions online at: www.compassrosebenefits.com/tutorials/how-to-submit-a-claim.
• Privacy and confidentiality of protected health information (PHI). View up-to-date privacy practices at: www.compassrosebenefits.com/privacy-practices.
• Approve or refuse the release of health records when authorization is required, except when disclosure is permitted or required by law.
• Be treated with consideration, dignity, and respect at all times.
• Be treated fairly and without discrimination based on race, color, national origin, age, disability, sex, or any other characteristic protected by applicable law.
• Access urgent or emergency health care or after-hours services when and where the need arises.
• Access to out-of-area care and covered services (as applicable).
• Participate in decisions involving your health care and receive accurate and complete information concerning your evaluation, diagnosis, treatment, and prognosis, unless providing information is medically contraindicated.
• Refuse to participate in research, if applicable.
• Access the network for primary and specialty care, including behavioral health care.
• Select and change providers. Access our provider directories at: www.compassrosebenefits.com/find-care/choosing-a-provider.
• Access to pharmaceutical management programs.
• Receive language assistance and interpretive services, as necessary, at no cost.
• Receive interpretive services or services for hearing or visual impairments, as necessary. Learn more at: www.compassrosebenefits.com/policies/section-1557.
• Obtain information about advance directives.
• Communicate with healthcare providers in confidence and have individually identifiable healthcare information protected.

As a member of the Compass Rose Health Plan, you are responsible for:

• Providing an accurate and complete health history, including information about over-the-counter and prescription medications, dietary supplements, and allergies or sensitivities.
• Following the treatment and care plan agreed upon with your healthcare providers.
• Asking questions when instructions or information are not understood.
• Informing providers about living wills, medical power of attorney, or other directives affecting care.
• Accepting personal financial responsibility for costs not covered by insurance, if applicable, and adhering to all applicable fees and payment policies.
• Treating healthcare providers, staff, and others with respect.
• Informing healthcare providers about other medical insurance coverage that you or your family members may have.
• Providing accurate contact and enrollment information and notifying the Plan of changes that may affect coverage or communications.

Need Assistance? Call the Compass Rose Health Plan at 888-438-9135.