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Starting January 1, 2025, Fidelis Care will provide outpatient behavioral health benefits to NJ FamilyCare members. Learn more about the behavioral health benefit changes (PDF).

Member Rights and Responsibilities

You have the right to:

  • Get information about our Plan, services, and providers;
  • Get information and make recommendations about your rights and responsibilities;
  • Have a say in our member rights and responsibilities policies and recommend changes to other policies and services we cover;
  • Talk openly about the care you need, no matter the cost or benefit coverage, your treatment options, and the risks involved (this information must be given in a way you understand);
  • Talk openly about the care you need, no matter the cost or benefit coverage, your treatment options, and the risks involved (this information must be given in a way you understand);
  • File an appeal or grievance about your Plan or the care we provide; also, know that if you do, it will not change how you are treated; and to know that you cannot be disenrolled from your Plan for filing an appeal or grievance;
  • Ask for and get information about the services available to you;
  • Have access to and a choice of qualified service providers;
  • Know your rights before getting approved services;
  • Get services without regard to race, religion, color, creed, gender, national origin, political beliefs, sexual orientation, marital status, or disability;
  • As a resident of an MLTSS community, to have a key to lock/unlock the home and bedroom doors, to have visitors of the Member’s choosing, to make and receive phone calls, to make independent schedules, and to have access to food at any time, unless otherwise determined in a documented person-centered process;
  • Have access to appropriate services that support your health and welfare;
  • Make decisions about your care needs;
  • Choose between a nursing facility and home-and community-based services (HCBS), whichever safely meets your needs;
  • To assume risk after being fully informed and able to understand the risks and effects of your decisions;
  • Take part in the development of your plan of care;
  • Request changes in services at any time, including requests to add, increase, decrease, or discontinue services;
  • Ask for and get from your care manager a list of names and duties of any person(s) who provide care services to you;
  • Get help and guidance from your care manager to resolve concerns and/or complaints about your care needs or services or providers;
  • Get written facility specific resident rights when you go into an institutional or residential setting;
  • Be informed of all the covered/required services you are entitled to, and are required by and/or offered by the institutional or residential setting, and any charges not covered by our Health Plan while in the facility;
  • Not to be transferred or discharged out of a facility except for medical necessity;
    –To protect your physical welfare and safety or the welfare and safety of other residents; or
    – After reasonable notice, when you fail to make payments to the facility that are based on your income level. 
  • Have us protect and promote your ability to use the rights listed in this document;
  • Have all rights and responsibilities mentioned here passed on to your chosen representatives;
  • Get information about the Plan, its staff, staff qualifications, and its contracts;
  • Not take part in or to leave programs and services offered by the Plan;
  • Know your care manager and know how to change your care manager;
  • Get support from us to make decisions with your care manager;
  • Be informed of all care management services available, even if a service is not covered, and to discuss options with your care manager;
  • Have information about you kept private and to know how we keep your data secure;
  • Make complaints to us and get details about the complaint process;
  • Get information in a way you can understand; and
  • Be treated with respect by our staff and recognition of your dignity and right to privacy.

You have the responsibility to:

  • Give your care manager all the information needed to develop a plan of care for you;
  • Understand your healthcare needs and work with your care manager to develop or change goals and services;
  • Work with your care manager to develop and/or change your plan of care when needed;
  • Understand the risks that come with decisions you make about your care;
  • Report any major changes to your health condition, medication, living arrangements, informal, and formal supports to your care manager;
  • Let your care manager know of any problems or if you are not happy with your care;
  • Follow our rules and/or the rules of an institutional or residential setting (including any cost share);
  • Ask questions if you do not understand something about your care or the Plan;
  • Give information that we and your providers need to give care to you;
  • Follow plans and instructions for care that you have agreed on with your provider(s);
  • Understand your health problems; and
  • Help set treatment goals that you and your provider(s) agree to.

We are committed to keeping your race, ethnicity, and language (REL), and sexual orientation and gender identity (SOGI) information confidential. Here are some of the ways we protect your information:

  • Keeping paper documents in locked file cabinets; 
  • Making sure that all electronic information is on physically secure media; and 
  • Keeping your electronic information in password-protected files. 

We may use or disclose your REL and SOGI information to perform our operations. These activities may include:

  • Designing intervention programs;
  • Designing and directing outreach materials;
  • Informing healthcare practitioners and providers about your language needs; or
  • Assessing healthcare disparities.

We will never use your REL and SOGI information for underwriting, rate setting, or benefit determinations. We will not disclose your REL or SOGI information to unauthorized individuals.