Member Rights & Responsibilities

Member Rights

As a Quartz member, you have the right:

• To ask for an interpreter and have one provided to you during any Quartz-covered service.
• To receive the information in another language or another format.
• To pick a personal doctor from primary care physicians (PCPs) or primary care clinics (PCCs) who participate in your Quartz plan’s provider network.
  • To get information about your rights and responsibilities as a Quartz member.
  • To get information about your Quartz plan’s covered or excluded services and health plan benefits and its primary and specialty care practitioners and providers.
• To know about the doctors you can see.
• To receive health care services as provided for in federal and state laws.
• All covered services must be available and accessible to you. When medically appropriate, services must be available 24 hours a day, seven days a week.
• To receive information about treatment options, including the right to request a second opinion. You have the right to have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• To get preventive care information.
• To give us ideas about these rights and responsibilities.
• To make decisions about your health care. You can also refuse care.
• To be treated with dignity and respect, regardless of race, age, gender, sexual orientation, or creed.  
• To privacy. You have the right to privacy and confidentiality in all communications and records about your health care.
• To be free from any form of restraint or seclusion used as means of force, control, ease, or reprisal.
• To know how to file a complaint, appeal, or grievance about Quartz and the care it provides.
• To be free to exercise your rights without adverse treatment by your Quartz plan, or the HMO and its network providers.
• You have the right to disenroll from your HMO program or Quartz plan if:
  • You move out of the HMO or plan’s service area.
  • Your plan or HMO does not, for moral or religious objections, cover a service you want.
  • You need a related service performed at the same time, not all related services are available within the provider network, and your PCP or another provider determines that receiving the services separately could put you at unnecessary risk.
  • Other reasons, including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with your care needs.
    
• Quartz BadgerCare Plus members:
  • You may switch HMOs without cause during the first 90 days of Quartz enrollment.
  • You have the right to switch HMOs, without cause, if the State imposes sanctions or temporary management on Quartz.
  • You have the right to receive information from Quartz regarding any significant changes with Quartz at least 30 days before the effective date of the change.

Your Civil Rights

All medically necessary covered services are available and will be provided in the same manner to all members. All persons or organizations connected with Quartz that refer or recommend members for services shall do so in the same manner for all members.

Quartz provides covered services to all eligible members regardless of the following:

• Age
• Color
• Disability
• National origin
• Race
• Sex

Member Responsibilities

As a Quartz member, it is your responsibility:

• To pick a personal doctor from Quartz’s list of primary care physicians or primary care clinics who participate in your plan’s network.
• To create a relationship with that doctor.
• To read your member handbook and ask questions about information you don’t understand.
• To be honest with your doctors and give them the information they need to take care of your health.
• To understand your health problems, ask questions about your health, and to take part in developing mutually agreed upon treatment goals, to the degree possible.
• To follow plans and instructions for care you have agreed to with your doctor.
• To follow the instructions your doctor gives you, including the plans and instructions of care you have agreed to.
• To have your Quartz member ID card with you and show them when you go to your doctor or hospital.
  
• Quartz BadgerCare Plus members: It’s your responsibility to carry your ForwardHealth ID card, along with your Quartz member ID card, with you and show them when you go to your doctor and hospital.
• To make healthy choices
• To keep your appointments or to give early notice if you must cancel.
• To show consideration and respect to health plan staff and health care providers.

If you’re a Quartz Medicare Advantage (HMO) member, you can find more details about your rights and responsibilities of your plan’s Evidence of Coverage document, which is available in your Quartz MyChart account.