Medicare member rights and responsibilities

You have the right to be treated with dignity, respect, and fairness at all times. We must obey laws against discrimination that protect you from unfair treatment. These laws say that we cannot discriminate against you (treat you unfairly) because of your race or color, age, religion, national origin, or any mental or physical disability you may have.

If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. You can also reach the Office for Civil Rights at 800-368-1019 (TTY 800-537-7697), or you can contact the regional Office for Civil Rights in your area.

Southern Regional Office for Civil Rights

The Southern Regional Office for Civil Rights covers North Carolina, Alabama, Florida, Georgia, Kentucky, Mississippi, South Carolina, and Tennessee.

Contact

Phone number: 800-368-1019

TTY number: 800-537-7697 (For the hearing and speech impaired)

Address

Office for Civil Rights, U.S. Department of Health and Human Services

Atlanta Federal Center, Suite 16T70
61 Forsyth Street, Southwest
Atlanta, GA 30303

There are federal and state laws that protect the privacy of your medical records and personal health information. We keep your personal health information private as protected under these laws. Any personal health information (PHI) that you give us when you enroll in this plan is protected.

We will make sure that unauthorized people do not see or change your records. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who is not providing your care or paying for your care.

There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used.

We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. For example, you have the right to look at your medical records, and to get a copy of the records (there may be a fee charged for making copies).

You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and determine whether the changes are appropriate).

You have the right to know how your health information has been given out and used for non-routine purposes. If you have questions or concerns about the privacy of your personal information and medical records, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You should get all of your prescriptions filled from an in-network pharmacy, that is, from pharmacies that contract with Blue Cross NC.

You have the right to go to any network pharmacy in order to get your prescriptions filled at the benefit level.

You have the right to timely access to your prescriptions. "Timely access" means that you can get your prescriptions filled within a reasonable amount of time.

You have the right to know about the different Medication Management Treatment Programs we offer and in which you may participate. You have the right to be told about any risks involved in your care. You have the right to refuse treatment. This includes the right to stop taking your medication. If you refuse treatment, you accept responsibility for what happens as a result of refusing treatment.

You have the right to get a detailed explanation from us if you believe that a network pharmacy has denied coverage for a drug that you believe you are entitled to get or care you believe you should continue to get.

You have the right to make a complaint if you have concerns or problems related to your coverage or care. "Appeals" and "grievances" are the two different types of complaints you can make. Which one you make depends on your situation. You can make a complaint on the Medicare complaint form⁠⁠.

If you make a complaint, we must treat you fairly (i.e., not discriminate against you). You have the right to get a summary of information about the appeals and grievances that members have filed against us in the past. To get this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

This website and your Evidence of Coverage tells you what you have to pay for prescription drugs as a member of Blue Cross NC. If you need more information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You have the right to an explanation from us about any bills you may get for medications not covered by your plan. We must tell you in writing why we will not pay for a medication, and how you can file an appeal to ask us to change this decision.

You have the right to get information from us about Blue Cross NC and our plans. This includes information about our financial condition and about our network pharmacies.

To get any of this information, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You have the right to disenroll from Blue Medicare Plans during certain periods by giving written notice to Blue Cross NC of your intent to do so. Coverage will end on the last day of the month following the date that Blue Cross NC receives your written request.

When can you end your membership in our plan?

There are only certain times during the year when you may voluntarily end your membership which include:

• Annual Open Enrollment Period: October 15 through December 7.
• Medicare Advantage Open Enrollment Period: January 1.
• Special Enrollment Period (SEP): If you qualify due to certain life events or special situations.

If you have questions about disenrolling or whether you’re eligible for a Special Enrollment Period, call Customer Service using the number on your ID card or contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

Important: If you go 63 days or longer without creditable prescription drug coverage, you may have to pay a late enrollment penalty if you enroll in a Medicare Part D plan later.

How to end your membership in our plan

In most cases, you will be automatically disenrolled from our plan when you:

• Enroll in another Medicare health plan, or
• Enroll in a separate Medicare prescription drug plan.

If you want to return to Original Medicare without joining a separate Medicare drug plan, you must send us a written request to disenroll. Send your written request to:

Blue Medicare Plans
PO Box 30010
Durham, NC 27702

You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask to be disenrolled. TTY users call 1-877-486-2048.

What happens until your membership ends?

Until your disenrollment becomes effective and your new Medicare coverage begins:

• Continue receiving your medical services, items, and/or prescription drugs through our plan.
• Continue using network providers and pharmacies.
• Continue paying any required copayments, coinsurance, or other cost-sharing amounts.

If your plan includes medical coverage and you are hospitalized on the day your membership ends, your hospital stay will continue to be covered by our plan until you are discharged, even if your new coverage starts before you are discharged from the hospital.

When can Blue Cross NC end your membership?

Blue Cross NC may disenroll you from our plan for any of the following reasons:

• You no longer have Medicare Part A and Part B.
• You move outside the plan's service area.
• You are away from our service area for more than six months.
• You become incarcerated.
• You are no longer a U.S. citizen or lawfully present in the United States.
• You lie or withhold information about other insurance you have that provides prescription drug coverage.
• You intentionally provided false information when enrolling that affects your eligibility.
• You engage in disruptive behavior that makes it difficult for us to provide medical care for you or other members of our plan.
• You allow someone else to use your membership card.
• You fail to pay plan premiums for two calendar months following the due date.
• You fail to pay a required Medicare Part D income-related monthly adjustment amount (IRMAA).

Your rights if Blue Cross NC ends your membership

Blue Cross NC cannot ask you to leave our plan for any health-related reason. If you believe you’re being asked to leave our plan because of a health-related reason, contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

If we end your membership in our plan, we must tell you our reasons for ending your membership in writing. We must also explain how you can file a grievance or make a complaint about our decision to end your membership. You have the right to make a complaint if we end your membership in our plan.

If you have questions or concerns about your rights and protections, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card.

You can also get free help and information from Seniors' Health Insurance Information Program (SHIIP). You can reach SHIIP at 855-408-1212. In addition, the Medicare program has written a booklet called "Your Medicare Rights and Protections." To get a free copy, call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048. You can call 24 hours a day, seven days a week. Or, you can visit medicare.gov⁠⁠⁠ to order this booklet or print it directly from your computer.

For concerns or problems related to your Medicare rights and protections described in this section, please call Blue Cross NC Customer Service at the number listed on the back of your member ID card. You can also get help from SHIIP by calling 855-408-1212.