Members, legal guardians of members, and legally authorized surrogates for members have certain responsibilities. It is important that you know your responsibilities. All members are responsible for learning how the CeltiCare plan works by reading the Evidence of Coverage.
Giving Information: You should give accurate and complete information about present conditions, past illnesses, hospitalizations, medications, and other matters about your health. You should make it known whether you clearly understand your care and what is expected of you. You need to ask questions of your doctor until you understand the care you are receiving. You need to review and understand the information you receive about CeltiCare. You need to know the proper use of services covered by CeltiCare.
Your Doctor’s Advice: You should follow the treatment plan suggested by providers of medical care. You should ask questions if you do not understand any part of the treatment plan. You should work with your PCP to develop treatment goals. If you do not follow the treatment plan, you have the right to be advised of the likely results of your decision.
ID Card: It is important that you show your CeltiCare ID card before you receive care.
Emergency Room Use: You should use any emergency room only when you think you have a medical emergency. For all other care, you should call your PCP.
Appointments: You need to keep appointments. If you cannot keep an appointment, you must call to cancel or reschedule. You should schedule appointments during office hours whenever possible.
Primary Care Provider (PCP): You should know the name of your assigned PCP. You should establish a relationship with your doctor. You may change your PCP verbally or in writing by contacting our Member Services Department.
Treatment: You should treat all CeltiCare staff, providers, and other members with respect and dignity. Any concerns that you have about your care should be communicated to CeltiCare in a useful manner.
Changes: You need to tell the Connector about any changes in your address, name, telephone number, or any changes in your family.
Other Medical Insurance: When you enroll in CeltiCare, you need to give all information about any other medical insurance coverage you have. If, at any time, you get other medical coverage besides your CeltiCare coverage, you must tell the Connector.
Costs: If you access care without following CeltiCare rules, you may be responsible for the charges. If applicable, you are responsible to pay your portion of the monthly Commonwealth premium and all co-payments at the time of service.
To learn more about your Rights as a CeltiCare Member click here or call CeltiCare Member Services at (866) 895-1786, TTY/TDD: (866) 614-1949, Monday through Friday, 8 am – 5 pm.