Member Resources

Additional Resources

For Erie County Residents Only

  • Functional Needs Form – In an emergency situation, this helps first responders understand your condition before they arrive on-site.

 

Member Rights

As a member of Elderwood Health Plan, you are entitled to your rights. We encourage you to know and use your rights listed below:

  • You have the right to be treated with respect and dignity.
  • You have the right to receive medically necessary care.
  • You have the right to request to change your care manager.
  • You have the right to timely access to care and services.
  • You have the right to privacy about your medical records and when you get treatment.
  • You have the right to get information on available treatment options and alternatives presented in a manner and language you understand.
  • You have the right to get information in a language you understand and you can get oral translation services free of charge.
  • You have the right to get information necessary to give informed consent before the start of treatment.
  • You have the right to get a copy of your medical records and ask that the records be amended or corrected.
  • You have the right to take part in decisions about your health care, including the right to refuse treatment.
  • You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • You have the right to get care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status or religion.
  • You have the right to be told where, when and how to get the services you need from your managed long-term care plan, including how you can get covered benefits from out-of-network providers if they are not available in the plan network.
  • You have the right to complain to the New York State Department of Health or your local department of Social Services and the right to use the New York State Fair Hearing System and/or a New York State External Appeal, where appropriate.
  • You have the right to appoint someone to speak for you about your care and treatment.
  • You have the Right to seek assistance from the Participant Ombudsman program.

 

Member Responsibilities

In order for you to receive the best care possible and, as an Elderwood Health Plan member, it is your responsibility to:

  • Learn and understand each right you have under this managed long-term care program.
  • Ask questions if you do not understand your rights.
  • Know the name of your primary care physician (PCP) and your care manager.
  • Know about your health care and the process for getting care.
  • Use providers who are in the Elderwood network of providers for services covered by this plan.
  • Get approval from your care manager or care management team, as required, before getting an Elderwood Health Plan covered service.
  • Understand emergency services are needed for sudden onset of a condition that poses a serious threat to your health or body function and not for care your primary care physician can provide.
  • Contact your care management team any time you have a change in health condition or receive new health services. 
  • Contact your care management team any time you have a change in your personal information.
  • Treat the health care professionals who are giving you care respectfully.
  • Tell Elderwood about your care needs, concerns, questions or problems.
  • Participate in managing your own health by telling your provider about your health care concerns and needs.
  • Notify Elderwood when you go away or out of town.
  • Make all required payments to Elderwood, if applicable.
  • Follow your care manager’s advice or talk to your care manager if you are unable or are unwilling to follow the care plan.
  • Protect your member ID card and show it when you get service.
  • Contact your care management team or Member Services toll free at 1-866-THE-PLAN (1-866-843-7526) right away if your address or phone number changes.