Members' Rights and Responsibilities

You have the right to:

  • Voice concerns about the service and care you receive without penalty or disenrollment
  • Register complaints and appeals concerning your health plan or the care provided to you
  • Receive timely responses to your concerns
  • Participate in decisions regarding your health care treatment options related to your condition
  • Choose physicians, health care professionals and other health care facilities who will participate in your care
  • Choose an Advance Directive to designate the kind of care you wish to receive should you be unable to express your wishes
  • Privacy and confidentiality for treatments, tests and procedures you receive
  • Obtain information regarding Assurant Health’s criteria for case closure
  • Receive notification and a rationale when case management services are changed or no longer needed
  • Refuse treatment or services, including case management services
  • Have coverage decisions and claims processed according to regulatory and contractual standards, when applicable
  • Ask questions regarding your medical plan coverage, the preauthorization process or claims payment
  • Receive information about the participating providers within the company's networks
  • Receive information regarding your prescription drug benefits and the Drug Formulary Program
  • Receive a certificate outlining the coverage to which you and/or your family members are entitled, and to whom benefits are paid
  • Request information on types of provider payment arrangements
  • Request the Quality Assurance Program Report

You have the responsibility to:

  • Read your certificate carefully
  • Know and confirm your benefits before receiving treatment
  • Review the Pre-existing Conditions Limitation in your policy certificate
  • Contact an appropriate health care professional when you have a medical need or concern
  • Keep scheduled appointments
  • Show your ID card before receiving health care services
  • Provide information needed for your care
  • Pay your financial obligations under the benefit plan
  • Participate in understanding your health problems and developing mutually agreed upon treatment goals
  • Follow agreed upon instructions and guidelines of physicians and health care professionals
  • Use emergency room services only for injury or illness that, in the judgment of a reasonable person, requires immediate treatment to avoid jeopardy to life or health
  • Know if you are covered by a PPO plan
  • Verify the medical care and treatment you receive is through participating doctors and hospitals if you are covered by a PPO plan and wish to receive maximum benefits. Please note that providers may move in and out of the network; also, a hospital or clinic may use both in-network and out-of-network providers. To ensure your chosen provider is in network each time you seek care, verify the provider’s participation by calling the network or visiting the network’s website, listed on your medical ID card
  • Present your drug ID card each time a prescription is filled
  • Obtain preauthorization for services indicated in your certificate
  • Notify Assurant Health and your providers of changes in your address or family status

Members’ Rights and Responsibilities apply only to current Assurant Health customers. The relevance of each may vary, depending on plan benefits.

Questions regarding the above can be submitted by writing or calling:

Customer Service Department
Assurant Health
501 West Michigan
Milwaukee, WI 53203
800-800-1212

We accept TTY (text telephone) calls if you are hearing or speech impaired. If English is not your primary language and you do not have an interpreter available, or if you have special needs, please let us know you need assistance.

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888-317-4325

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