Skip to Content

Managed health care programs: member rights – Ohio Admin. Code 5160-26-08.3

Link to the law
This will open in a new window

Managed health care program members have the following rights:

  • To be ensured of confidential handling of information concerning their diagnoses, treatments, prognoses, and medical and social history;
  • To be provided information about their health;
  • To have information about their health made available to the individual legally authorized by the member to have such information or the person to be notified in the event of an emergency when concern for a member’s health makes it inadvisable to give him/her such information;
  • To have the opportunity to participate in decisions involving their health care unless contraindicated;
  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand;
  • To request and receive a copy of their medical records;
  • To be able to request that their medical records be amended or corrected;
  • To be afforded the opportunity to approve or refuse the release of information except when release is required by law;
  • To have the opportunity to refuse treatment or therapy after be counseled relative to the consequences of such decision;
  • To be assured that all written member information provided by the program is available in the prevelant non-English languages of members in the program’s service area and in alternative formats and in an appropriate manner that takes into considerations the special needs of members;
  • To be assured that oral interpretation and oral translation services are available at no cost to members;
  • To be assured that the services of sign language assistance are available to hearing impaired  members;
  • To refuse student care;
  • To refuse to participate in experimental research;
  • To formulate advance directives;
  • To change primary care providers no less often than monthly;
  • To be assured that the program will comply with all applicable federal and state laws and other laws regarding privacy and confidentiality;
  • To choose his or her  health professional to the extent possible and appropriate;
  • To be assured that female members have direct access to a woman’s health specialist within the network for covered care necessary to provide women’s routine and preventative health services; and
  • To be provided a second opinion from a qualified health professional within the programs’ panel

Current as of June 2015