Rights and responsibilities

Rights and responsibilities on the ExxonMobil Employee Medical HMO - Aetna Select Plan

Your rights and responsibilities

As a plan participant, you have a right to:

  • Get up-to-date information about the doctors and hospitals participating in the Plan.
  • Obtain primary and preventive care from the PCP you chose from the Plan’s network.
  • Change your PCP to another available PCP who participates in the Aetna network.
  • Obtain covered care from participating specialists, hospitals and other providers.
  • Be referred to participating specialists who are experienced in treating your chronic illness.
  • Be told by your doctors how to make appointments and get health care during and after office hours.
  • Be told how to get in touch with your PCP or a back-up doctor 24 hours a day, every day.
  • Call 911 (or any available area emergency response service) or go to the nearest emergency facility in a situation that might be life-threatening.
  • Be treated with respect for your privacy and dignity.
  • Have your medical records kept private, except when required by law or contract, or with your approval.
  • Help your doctor make decisions about your health care.
  • Discuss with your doctor your condition and all care alternatives, including potential risks and benefits, even if a care option is not covered.
  • Know that your doctor cannot be penalized for filing a complaint or appeal.
  • Know how the Plan decides what services are covered.
  • Know how your doctors are compensated for the services they provide. If you would like more information about Aetna’s physician compensation arrangements, visit their website at www.aetna.com. Select DocFind from the drop-down menu under Quick Tools, then under “How do I learn more about:” select the type of plan you’re enrolled in.
  • Get up-to-date information about the services covered by the Plan — for instance, what is and is not covered and any applicable limitations or exclusions.
  • Get information about co-payments and fees you must pay.
  • Be told how to file a complaint, grievance or appeal with the Plan.
  • Receive a prompt reply when you ask the Plan questions or request information.
  • Obtain your doctor’s help in decisions about the need for services and in the grievance process.
  • Suggest changes in the Plan’s policies and services.

As a plan participant, you have a right to:

  • Choose a PCP from the Plan’s network and form an ongoing patient-doctor relationship.
  • Help your doctor make decisions about your health care.
  • Tell your PCP if you do not understand the treatment you receive and ask if you do not understand how to care for your illness.
  • Follow the directions and advice you and your doctors have agreed upon.
  • Tell your doctor promptly when you have unexpected problems or symptoms.
  • Consult with your PCP for non-emergency referrals to specialist or hospital care.
  • See the specialists your PCP refers you to.
  • Make sure you have the appropriate authorization for certain services, including inpatient hospitalization and out-of-network treatment.
  • Call your PCP before getting care at an emergency facility, unless a delay would be detrimental to your health.
  • Understand that participating doctors and other health care providers who care for you are not employees of Aetna and that Aetna does not control them.
  • Show your ID card to providers before getting care from them.
  • Pay the co-payments required by the Plan.
  • Call Member Services if you do not understand how to use your benefits.
  • Promptly follow the Plan’s grievance procedures if you believe you need to submit a grievance.
  • Give correct and complete information to doctors and other health care providers who care for you.
  • Treat doctors and all providers, their staff, and the staff of the Plan with respect.
  • Advise Aetna about other medical coverage you or your family members may have.
  • Not be involved in dishonest activity directed to the Plan or any provider.
  • Read and understand your Plan and benefits. Know the co-payments and what services are covered and what services are not covered.