Ala. Admin. Code r. 420-5-6-.12

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-5-6-.12 - Enrollee Rights

(1) A health maintenance organization shall develop and adhere to written procedures for informing enrollees of at least the following rights:

(a) An enrollee has the right to timely and effective redress of grievances through a system established under 420-5-6-.08;

(b) An enrollee has the right to obtain current information concerning a diagnosis, treatment, and prognosis from a physician or other provider in terms the enrollee can be reasonably expected to understand. When it is not advisable to give such information to the enrollee, the information shall be made available to an appropriate person on the enrollee's behalf;

(c) An enrollee has the right to be given the name, professional status, and function of any personnel providing health services to him;

(d) An enrollee has the right to give his informed consent before the start of any surgical procedure or treatment;

(e) An enrollee has the right to refuse any drugs, treatment, or other procedure offered to him by the health maintenance organization or its providers to the extent provided by law and to be informed by a physician of the medical consequences of the subscriber's refusal of any drugs, treatment, or procedure;

(f) When emergency services are necessary, an enrollee has the right to obtain such services without unnecessary delay;

(g) An enrollee has the right to have all records pertaining to his medical care treated as confidential unless disclosure is otherwise permitted by law;

(h) An enrollee has the right to all information in his medical records unless access is specifically restricted by the attending physician for medical reasons;

(i) An enrollee has the right to be advised if a health care facility or any of the providers participating in his care propose to engage in or perform human experimentation or research affecting his care or treatment. An enrollee or legally responsible party on his behalf may, at any time, refuse to participate in or continue in any experimental or research program to which he has previously given informed consent; and

(j) An enrollee has the right to be informed of these rights listed in this subsection.

(2) No health maintenance organization may, in any event, cancel or refuse to renew an enrollee solely on the basis of the health of an enrollee.

Author: Department of Public Health

Ala. Admin. Code r. 420-5-6-.12

Filed September 1, 1982. Repealed and New Rule adopted in lieu thereof: Filed March 31, 1987. Amended: Filed January 20, 1999; effective February 24, 1999.

Statutory Authority:Code of Ala. 1975, §§ 22-2-2(6), etseq., 22-21-20, etseq., 27-21A-1, etseq.