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Member Rights and Responsibilities

Your Rights and Responsibilities

As a member of Trillium Community Health Plan, you have rights. There are also responsibilities or things you must do when you get OHP. If you have any questions about the rights and responsibilities listed here, call Customer Service at 877-600-5472.

You have the right to exercise your member rights without a bad response or discrimination. You can make a complaint if you feel like your rights have not been respected. Learn more about making complaints on page 120 of the Member Handbook. You can also call an Oregon Health Authority Ombudsperson at 877-642-0450 (TTY 711). You can send them a secure email at the OHA Ombuds Program webpage.

There are times when people under age 18 (minors) may want or need to get health care services on their own. Minors 15 years and older can get medical and dental care without parental consent. To learn more, read “Minor Rights: Access and Consent to Health Care.” This booklet tells you the types of services minors of any gender can get on their own and how their health records may be shared. You can read it at the OHP webpage. Click on “Minor rights and access to care.” Or download "Understanding Minor Consent and Confidentiality in Health Care in Oregon (PDF)." 

Your rights as an OHP member

  • Be treated with dignity, respect, and consideration for your privacy.
  • Be treated by providers the same as other people seeking health care.
  • Have a stable relationship with a care team that is responsible for managing your overall care.
  • Not be held down or kept away from people because it would be easier to:
    • Care for you, 
    • Punish you, 
    • Get you to do something you don’t want to do.

  • Materials explained in a way and in a language you can understand. (See page 3 of the Member Handbook)
  • Materials, like this handbook, that tell you about CCOs and how to use the health care system.
  • Written materials that tell you your rights, responsibilities, benefits, how to get services, and what to do in an emergency. 
    • You have the right to make recommendations regarding this rights and responsibilities policy.
  • Information about your condition, treatments, and alternatives, what is covered, and what is not covered. This information will help you make good decisions about your care. Get this information in a language and a format that works for you.
  • A health record that keeps track of your conditions, the services you get, and referrals. (See page 13 of the Member Handbook) You can:
    • Have access to your health records.
    • Share your health records with a provider.
  • Written notice mailed to you of a denial or change in a benefit before it happens. You might not get a notice if it isn’t required by federal or state rules. 
  • Written notice mailed to you about providers who are no longer in-network. In-network means providers or specialists that work with Trillium Community Health Plan. (See page 31 of the Member Handbook)
  • Be told in a timely manner if an appointment is cancelled.

  • Care and services that put you at the center. Get care that gives you choice, independence, and dignity. This care will be based on your health needs and it will meet standards of practice.
  • Services that consider your cultural and language needs and are close to where you live. If available, you can get services in non-traditional settings such as online. (See page 84 of the Member Handbook)
  • Care coordination, community-based care, and help with care transitions in a way that works with your culture and language. This will help keep you out of a hospital or facility.
  • Services that are needed to know what health condition you have.
  • Help to use the health care system. Get the cultural and language support you need. (See page 3, 76 of the Member Handbook) This could be:
    • Certified or qualified health care interpreters.
    • Certified traditional health workers.
    • Community health workers.
    • Peer wellness specialists.
    • Peer support specialists.
    • Doulas.
    • Personal health navigators.
  • Help from CCO staff who are fully trained on CCO policies and procedures.
  • Covered preventive services. (See page 45 of the Member Handbook)
  • Urgent and emergency services 24 hours a day, 7 days a week without approval or permission. (See page 90 of the Member Handbook)
  • Referrals to specialty providers for covered coordinated services that are needed based on your health. (See page 43 of the Member Handbook)
  • Extra support from an OHP Ombudsperson (See page 66 of the Member Handbook)

  • Choose your providers and to change those choices. (See page 31 of the Member Handbook)
  • Get a second opinion. (See page 34 of the Member Handbook)
  • Have a friend, family member, or helper come to your appointments.
  • Be actively involved in making your treatment plan.
  • Agree to or refuse services. Know what might happen based on your decision. (A court-ordered service cannot be refused.)
  • Refer yourself to behavioral health or family planning services without permission from a provider.
  • Make a statement of wishes for treatment. This means your wishes to accept or refuse medical, surgical, or behavioral health treatment. It also means the right to make directives and give powers of attorney for health care, listed in ORS 127. (See page 114 of the Member Handbook)
  • Make a complaint or ask for an appeal. Get a response from Trillium Community Health Plan when you do this. (See page 120 of the Member Handbook)
    • Ask the state to review if you don’t agree with Trillium Community Health Plan’s decision. This is called a hearing.
  • Get free certified or qualified health care interpreters for all non-English languages and sign language. (See page 4 of the Member Handbook)

Your responsibilities as an OHP member

  • Treat Trillium Community Health Plan staff, providers, and others with respect.
  • Be honest with your providers so they can give you the best care.

  • If you get OHP, you must report certain changes about you and your household. Your OHP approval letter tells you what you must report and when. You can report changes in one of these ways:

There are other rights and responsibilities you have as an OHP member. OHP shared these when you applied. You can find a copy at the Oregon Department of Human Services Benefits webpage under the "Rights and Responsibilities" link.

  • Choose or help choose your primary care provider or clinic.
  • Get yearly checkups, wellness visits, and preventive care to keep you healthy.
  • Be on time for appointments. If you will be late, call ahead or cancel your appointment if you can’t make it.
  • Bring your medical ID cards to appointments. Tell the office that you have OHP and any other health insurance. Let them know if you were hurt in an accident.
  • Help your provider make your treatment plan. Follow the treatment plan and actively take part in your care.
  • Follow directions from your providers or ask for another option.
  • If you don’t understand, ask questions about conditions, treatments, and other issues related to care.
  • Use information you get from providers and care teams to help you make informed decisions about your treatment.
  • Use your primary care provider for test and other care needs, unless it’s an emergency.
  • Use in-network specialists or work with your provider for approval if you want or need to see someone who doesn’t work with Trillium Community Health Plan.
  • Use urgent or emergent services appropriately. Tell your primary care provider within 72 hours if you do use these services.
  • Help providers get your health record. You may have to sign a form called a Release of Information at your doctor’s office.
  • Tell Trillium Community Health Plan if you have any issues, complaints, or need help.
  • Pay for services that are not covered by OHP. 
  • If you get money because of an injury, help Trillium Community Health Plan get paid for services we gave you because of that injury.