WHAT YOU NEED TO KNOW ABOUT YOUR COVERAGE
Delivering trusted and accessible information to our members about their health plan is a core part of the Common Ground Healthcare Cooperative (CGHC) mission. We want to give members the tools to be educated healthcare consumers, and we do not believe in fine print.
The resources here on this page describe what you need to know about your health coverage. We consistently update these documents to make things relevant and easy to understand for our members.
It is important to us that all members understand their rights as a CGHC member. Our members have the right to:
- Receive information about CGHC, its services, its providers and Member rights and responsibilities.
- Be treated with respect and dignity by CGHC employees, contracted providers, vendors, and health care professionals.
- Privacy and confidentiality regarding their health and care.
- Participate with providers in making decisions about their health care.
- A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Voice complaints or concerns about CGHC or any of its network providers.
- Appeal any decision made by CGHC and to receive a response within a reasonable amount of time.
- Make recommendations regarding CGHC’s Member rights and responsibilities policy.
- Choose an advance directive to designate the kind of care they wish to receive should they become unable to express their wishes.
- Have a safe, secure, clean, and accessible health care environment.
- Have access to emergency health care services in cases where a “prudent layperson” acting reasonably would believe that an emergency existed.
Given that the health of CGHC members impacts the financial well-being of all other CGHC members, those that purchase our insurance also have certain responsibilities. It is the responsibility of our members to:
- Pay their premiums.
- Comply with all provisions of the policy outlined in the Certificate of Coverage, including Prior Authorization requirements.
- Know and confirm their benefits before receiving treatment.
- Show their ID card before receiving health care services.
- Follow agreed upon instructions and guidelines for care.
- Understand their health problems and develop mutually agreed upon treatment goals, to the degree possible.
- Provide accurate information, to the extent possible, that CGHC and their provider require to care for them, or to make an informed coverage determination.
- Use in-network providers for health care benefits and services, except where services are authorized by their health plan, or in the event of emergencies.
- Pay appropriate co-payments, coinsurance and deductibles to participating providers when services are received.
- Pay full charges incurred for non-covered services; EPO subscribers to pay full charges for out-of-network services; PPO subscribers to pay balance remaining for out of network services.