Member Rights & Responsibilities


You or your doctor can get a copy of these rights and responsibilities. Call us to ask us to mail, email or fax a copy.

Member rights

You have the right:

  • To be treated with respect and regard for your dignity and privacy.

  • To take part in decisions about your health care.

  • To refuse treatment.

  • To be free from threats or acts to coerce, punish or retaliate against you, as noted in federal rules. 

  • To ask for and get a copy of your medical records and request that they be changed or corrected.

  • To access health care services that compare in amount, length and scope to those under Medicaid fee-for-service (FFS). You can also reasonably expect these services to achieve the purpose for which they are given.

  • To get appropriate services and not have them denied or reduced solely due to the diagnosis, type of illness or medical condition.

  • To get all information in a manner and format that is easy to understand. This includes, among other things, enrollment notices, informational materials and treatment options.

  • To get help from both SCDHHS and us in understanding our rules and benefits.

  • To get free translation services for all non-English languages.

  • To get free oral interpretation services.

  • To get information, as a potential member, about the basic features of managed care so that you can make an informed choice. This includes who may or may not enroll in the program. It also includes what we must do to coordinate care in a timely manner.

  • To get information on our services. This includes but is not limited to:

    • Benefits we cover.

    • How to get benefits, including any prior authorizations you may need.

    • Cost sharing you may have.

    • Service area. 

    • Names, locations and telephone numbers of and non-English language spoken by network providers. This includes, at a minimum, PCPs, specialists and hospitals.

    • Limits on your freedom of choice among network providers.

    • Providers not taking new patients.

    • Benefits we do not offer but that you can still get. This includes how to get those benefits and how to get transportation.

  • To get a full description of disenrollment rights at least each year.

  • To get notice of any major changes in your benefits at least 30 days before the change takes effect.

  • To learn how to file a grievance and appeal.

  • To learn how to ask for a state fair hearing

  • To get information on emergency and after-hours coverage. This includes, but is not limited to:

    • What we consider emergency medical conditions, emergency services and post-stabilization services.

    • That emergency services do not need prior authorization.

    • How to get emergency services.

    • Where to get emergency and post-stabilization services that we cover.

    • Your right to use any hospital or other place for emergency care.

    • Post-stabilization care services rules.

  • To get our policy on referrals for specialty care and other benefits your PCP does not provide.

  • To have us protect your privacy.

  • To use these rights without harming the way we, our providers or SCDHHS treats you.

  • To frankly discuss appropriate or medically necessary treatment options, regardless of cost or benefit coverage.

  • To voice complaints or appeals about us or the care you get.

  • To suggest changes to this policy.


Member Responsibilities

You have these responsibilities:

  • Tell us and the state Medicaid program when your life changes. This includes if you move, change your phone number or get other insurance. It also means if you are pregnant or the number of people in your household changes. Please also tell us if your ID card is lost or stolen.

  • Show your ID cards each time you get care.

  • Keep and be on time for doctor visits. When you must cancel or be late, call the doctor’s office and let them know.

  • Treat your PCP and staff with respect. 

  • Work with your doctors to understand your health and set your treatment plan.

  • Ask questions and make sure you understand what your doctor tells you.

  • Follow the treatment plan you and your doctor have worked out. Tell your doctor if you can’t follow the plan.

  • Give your doctors and us as much information as you can. We use it to help you get well and stay well.

  • Know how to seek emergency care. 

  • Use the emergency room only for true emergencies, not routine care.

  • Read all of our materials carefully when you enroll. 

  • Follow the rules of our plan.

  • Fill out and send your annual renewal form when you get it from S.C. Healthy Connections Medicaid.

  • Call us when you need us.