Your Rights and Responsibilities

You have the right to understand how Mass Advantage works and what your coverage includes. This means you have the right to:

• Get clear, easy to understand information about Mass Advantage, your plan, the services we offer and the providers in our network.
• Receive Evidence of Coverage (EOC) and your Member Rights and Responsibilities information, so you always understand your coverage and what to expect from your plan.
• Receive information about your plan, the qualifications of in-network providers, and how to use your services. Asking questions when anything is unclear – such as your benefits, limits, or authorization steps – helps ensure you fully understand your coverage and how to use your plan.

You have the right to know about your medical care, treatment options and health records. This means you have the right to:

• Work with your providers to make decisions about your health care.
• Honest discussions with your providers about all treatment options that are appropriate or medically necessary for your condition, no matter the cost or plan coverage.
• Understand your health conditions and work with your providers to set treatment goals.
• Seek second opinions from in-network providers.
• Request a copy of your health and claims records and other health information we have about you.

You have the right to be treated fairly, respectfully and with dignity. This means you have the right to:

• Receive service and care that respects your dignity and treats you fairly, regardless of your race, gender, age, or financial situation.
• Speak up and exercise your rights without fear of punishment or discrimination.

You have the right to ask for appeals and make complaints. This means you have the right to:

• Question a decision (appeal) we have made and receive a timely response.
• Voice concerns, complaints, or opinions about your care, treatment, or any part of your Mass Advantage plan.
• File a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to
  • 200 Independence Avenue, S.W., Washington, D.C. 20201
  • calling (877) 696-6775
  • or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

You have the right to confidentiality, privacy, and security. This means you have the right to:

• Review our Privacy Policy and ask questions about how we protect your personal health information, like your name, address and other details that may directly identify you.
• Ask us to limit what we use or share by asking us not to share certain health information for treatment, payment or our operations as long as your care is not impacted.
• Get a list of those with whom we’ve shared your information.

You have a responsibility to provide information that the organization and its providers need to manage your care. This means you are responsible for:

• Giving accurate and complete information about your health, medical history, and symptoms when asked.
• Letting your providers know about all medicines you are taking including prescription drugs, over-the-counter medicines, vitamins and supplements.
• Responding to reasonable requests for information that help the organization manage your benefits and services.

You have a responsibility to understand your health conditions and to work with your providers to develop and follow mutually agreed-upon treatment goals and care plans. This means you are responsible for:

• Actively participating in decisions about your care, including setting treatment goals that reflect your needs, preferences and values.
• Following the treatment plans, instructions and medications that you and your provider have agreed are right for your care.
• Asking questions if you do not understand your care plan or instructions so you can make informed decisions about your health.

Changes to the Terms of this Notice:

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our website.

Your Rights and Responsibilities PDF