UPMC Health Plan
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Member Rights & Responsibilities

As a member of Community Care you have the following Rights:


One of your most important rights is the right to confidentiality. This means that we will not share information about your services without your permission. You have the right to refuse to allow release of information about your care except when:

  • The information is required as part of the monitoring activities of Community Care, your County and/or the State.
  • You or someone else must be protected from danger. The law requires that information about your care be shared with or without your permission. If this were the case, we would only share the information necessary to get you or the other person to safety.

Other Rights

  • To receive services and use clinics, hospitals and other programs without regard to your race, color, religion, lifestyle, sexual orientation, disabilities, national origin, age, gender, or income. To be treated in a considerate and respectful manner at all times.
  • To receive services in a place where your privacy is protected.
  • To choose a provider from the Community Care provider list, and change to another provider if you are dissatisfied.
  • To have your information kept private and confidential.
  • To know the name and the professional qualifications of any provider who is caring for you
  • To review the general report of Community Care' s responses to member complaints and grievances.
  • To receive information about the guidelines used by Community Care in decision making about your care.
  • To help with the development of your treatment plan and to understand the services you are receiving, why you are receiving them and what to expect.
  • To receive the information you need in order to make decisions about your care.
  • To work with providers or interpreters who understand you and your community.
  • To ask for and receive information about Community Care that is clear and easy to understand.
  • To know the procedure for requesting to see your record at Community Care.
  • To express your dissatisfaction about any decision made by Community Care or by one of our providers through a fair process that is easy to follow.


As a member of Community Care you have the following Responsibilities:

  • Tell your service provider all of the information you know about your physical and mental health, including any medicines you have taken or are taking.
  • Tell your family doctor (primary care physician) that you are receiving counseling services or taking medications prescribed by a psychiatrist.
  • Carry your Community Care I.D. card with you.
  • Seek emergency care at a Community Care participating hospital whenever possible.
  • Notify Community Care within 24 hours if emergency treatment is received at a hospital that is out of the area or not part of the Community Care Provider Network. (If you present your Community Care ID card, the hospital will call us for you.)
  • Keep your appointments or cancel them in advance whenever possible. Participate in planning your treatment and follow it.
  • Notify your provider if you decide to stop or change treatment.
  • Inform Community Care of any other insurance you have or of changes that might affect your membership. Be sure to tell your provider of any change in your medical assistance coverage as soon as it happens.
  • To know the licensure, certification, and accreditation status of Community Care or of its providers.