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Members' Rights and Responsibilities

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As a member of First Priority Health (FPH) or First Priority Life Insurance Company (FPLIC) you have certain rights and responsibilities which you should be aware of in order to maximize your benefits:

Member Rights

You have the right to:

  1. Receive information about Highmark, its products and services, its practitioners and providers and members’ rights and responsibilities.
  2. Be treated with respect and recognition of your dignity and right to privacy.
  3. Participate with practitioners in decision making regarding your health care. This includes the right to be informed of your diagnosis and treatment plan in terms that you understand and participate in decisions about your care.
  4. Have a candid discussion of appropriate and/or medically necessary treatment options for your condition(s), regardless of cost or benefit coverage. Highmark does not restrict the information shared between practitioners and patients and has policies in place, directing practitioners to openly communicate information with their patients regarding all treatment options regardless of benefit coverage.
  5. Voice a complaint or appeal about Highmark or the care provided, and receive a reply within a reasonable period of time.
  6. Make recommendations regarding the Highmark Members’ Rights and Responsibilities policies.

Member Responsibilities

You have the responsibility to:

  1. Supply to the extent possible, information that the organization needs in order to make care available to you, and that its practitioners and providers need in order to care for you.
  2. Follow the plans and instructions for care that you have agreed on with your practitioners.
  3. Communicate openly with the physician you choose. Ask questions and make sure you understand the explanations and instructions you are given, and participate in developing mutually agreed upon treatment goals. Develop a relationship with your doctor based on trust and cooperation. If you have any questions, please call Member Service at the toll-free number listed on your identification card.