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Member rights, responsibilities and privacy

Notice of Privacy Practices (PDF) Report fraud, waste, or abuse

Keystone First is committed to treating members with respect and dignity. Keystone First, and its network of doctors and other providers of services, do not discriminate against members based on race, sex, religion, national origin, disability, age, sexual orientation, or any other basis prohibited by law. As a member, you have the following rights and responsibilities:

Member rights

You have the right to:

  • Know about Keystone First and its health care providers.
  • Get information about Keystone First, its health care providers, and member rights and responsibilities.
  • Get information and know about your benefits and services.
  • Get information about the cost of health care services.
  • Have your medical records and care kept confidential.
  • Expect that Keystone First will give you a copy of its Notice of Privacy Practices (PDF) without your requesting it.
  • Privacy of your personal and health information.
  • Approve or deny the release of identifiable medical or personal information, except when the release is required by law.
  • Be treated with dignity and respect by your health care providers and Keystone First.
  • Talk with your health care provider about treatment plans.
  • Get information from a health care provider on available treatment options and alternatives, given in a way you understand.
  • Talk to your health care provider about the kinds of care you can choose to meet your medical needs regardless of cost or benefit coverage.
  • Voice complaints about and/or appeal decisions made by Keystone First and its health care providers.
  • File for a fair hearing with the Department of Human Services.
  • Get materials and/or help in alternate languages and formats, if necessary.
  • Make an advance directive.
  • Ask for and receive a copy of your medical records in accordance with applicable federal and state laws.
  • Be given an opportunity to make suggestions for changes in the Keystone First policies and procedures.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • Be a part of the decisions about your health care, including the right to refuse treatment. Your decision to do so will not negatively affect the way you are treated by Keystone First, its health care providers or the Department of Human Services.
  • Ask that any communication that has protected health information in it from Keystone First be sent to you by alternative means or to an alternative address.
  • Ask that Keystone First amend certain protected health information.
  • Ask for a list of disclosures of protected health information.

For more information or to make suggestions, please call Member Services.

Member responsibilities

We need you to help us. Please remember that you have a responsibility to:

  • Let Keystone First and your health care providers know of any changes that may affect your membership, health care needs or benefits. Some examples include, but are not limited to the following:
    • You are pregnant.
    • You have a new baby.
    • Your address or phone number changes.
    • You or one of your children has other health insurance.
    • You have a special medical condition.
    • Your family size changes, or
    • You move out of the county or state.
REMEMBER: You must also call your County Assistance Office (CAO) or the Customer Service Center at 1-877-395-8930 to let them know of your changes. If you live in Philadelphia, please call 1-215-560-7226.
  • Keep your benefits up to date with your caseworker at your County Assistance Office. Find out when your benefits will end. Make sure all your information is up to date so you can keep your benefits.
  • Work with Keystone First and our health care providers. This means you must follow the guidelines given to you about Keystone First and you must follow your health care provider's instructions about your care.  This includes:
    • Making appointments with your health care provider.
    • Canceling appointments when you cannot make your appointment.
    • Calling Keystone First when you have questions.
  • Treat your health care providers and staff with respect and dignity.
  • Talk with your health care provider to agree on goals for your treatment, to the degree you are able to do so.
  • Talk with your health care provider so you can understand your health problems, to the degree you are able to do so.

If you have any questions about your responsibilities or for more information, please call Member Services.