CHIP member rights and responsibilities

Keystone Health Plan® Central, and its network of doctors and other providers of services, do not discriminate against members based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law. As a member of the Children’s Health Insurance Program (CHIP) of Pennsylvania, you have the following rights and responsibilities.

You have a right:

  • To receive information about your rights and responsibilities.
  • To be treated with respect, and recognition of your dignity and need for privacy.
  • To be provided with information about Keystone Health Plan Central, its services, the practitioners providing care, and members’ rights and responsibilities.
  • To know about policies that can affect your child’s enrollment.
  • To be able to choose providers, within the limits of the Keystone Health Plan Central network, including the right to refuse treatment from specific practitioners.
  • To request a specialist to serve as your child’s primary care physician if your child has certain special medical needs or diagnoses.
  • To participate in decision making regarding your child’s healthcare, including the right to refuse treatment, and to express preferences about future treatment decisions.
  • To have a healthcare provider, acting within the lawful scope of practice, discuss medically necessary care and advise or advocate appropriate care with you or on your behalf, including information regarding the nature of treatment options; risks of treatment; alternative therapies; and consultation or tests that may be self-administered; without any restriction or prohibition from Keystone Health Plan Central.
  • To be informed by a physician about what may happen if drugs, treatments, of procedures are refused.
  • To give informed consent before the start of any procedure or treatment.
  • To ensure your child receives timely care in the case of an emergency.
  • To refuse to participate in medical research projects.
  • To question decisions made by Keystone Health Plan Central or its network providers, and to file a complaint or grievance regarding any medical or administrative decisions you disagree with.
  • To file a grievance about Keystone Health Plan Central or care provided and to file a CHIP review appeal with the Department.
  • To have access to your medical records in accordance with applicable federal and state laws and the right to request that they be amended or corrected.
  • To expect information that you provide to Keystone Health Plan Central and anything you or your child discuss with the healthcare provider will be treated confidentially, and will not be released to others without your permission.
  • To make recommendations regarding Keystone Health Plan Central’s members’ “rights and responsibilities” policy.
  • To exercise your rights without adversely affecting the way Keystone Health Plan Central, its providers, and state agencies may treat you.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.

You have a responsibility:

  • To understand how CHIP, brought to you by Keystone Health Plan Central, works by reading the handbook and other information made available to you.
  • To follow the guidelines set forth in the handbook and in other information made available to you, and ask questions about how to access healthcare services appropriately.
  • To inform Keystone Health Plan Central and your child’s providers about any information that may affect your child’s membership or right to program benefits, including other health insurance policies your child/you becomes covered under.
  • To supply up-to-date medical information to Keystone Health Plan Central and its providers so they can provide your child/you with appropriate care.
  • To be sure that your primary care provider has all of your child’s medical records, including those from other doctors.
  • To contact your child’s primary care provider first for all medical care except in the case of a true emergency.
  • To consent to the proper use of your child’s health information.
  • To treat your child’s providers with dignity and respect, which includes being on time for appointments and calling ahead if you need to cancel an appointment.
  • To provide a safe environment for services administered in your home.
  • To learn about your child’s health problems and work with providers to develop a plan for your child’s care.
  • To follow the instructions or guidelines you receive from the provider, such as taking prescriptions as directed and attending follow up appointments.
  • To take full responsibility for any consequences of your decision to refuse treatment on your child’s behalf.
  • To contact Keystone Health Plan Central if your child is admitted to the hospital or in an emergency room within 24 hours or as soon as possible.
  • To use your child’s member ID card to access care.
  • To pay any applicable fees.

CHIP coverage is issued by Keystone Health Plan® Central through a contract with the Commonwealth of Pennsylvania. Blue Cross DentalSM and Blue Cross VisionSM are issued by Capital Advantage Assurance Company®. Capital Advantage Assurance Company and Keystone Health Plan Central are subsidiaries of Capital Blue Cross. All are independent licensees of the Blue Cross Blue Shield Association. Communications are issued by Capital Blue Cross in its capacity as administrator of programs and provider relations.