• Does the plan have a written policy that states its commitment to treating members in a manner that respects their rights?
• Does the policy state the plan’s expectations of members’ responsibilities?

2.    Distribution of Rights Statement to Members and Practitioners (RR 2)

• Does the plan distribute to members and participating practitioners its policy on members’ rights and responsibilities?

3.    Policies for Complaints and Appeals (RR 3)

• Does the plan have written policies and procedures for the timely resolution of member complaints and appeals?

4.    Subscriber Information (RR 4)

• Does the plan provide written information about benefits and charges for which members are responsible, including co-payments?
• Does the plan provide written information for members on how to obtain care?
• Does the plan provide written information for members about how to file a complaint or appeal?
• When a practitioner leaves the plan, does the plan provide affected members with sufficient notice, and does it help the members choose a new practitioner?

5.    Physician and Hospital Directories (RR 5)

• Does the plan provide a searchable Web based directory of its physicians and hospitals?
• Does the directory contain the most current information on each physician and hospital?
• Does the plan test its directory for ease or use and understanding?
• Is the directory available in other formats such as print and telephonic?

6.    Privacy and Confidentiality (RR 6)

• Does the plan take steps to protect the privacy of members’ information and records?
• Does the plan inform members, practitioners and potential members of these policies?

7.    Marketing Information (RR 7)

• Do the plan’s marketing communications materials describe its procedures for approving or denying coverage; covered benefits, including pharmacy benefits; noncovered services; availability of practitioners and providers; and any applicable restrictions?
• Does the plan monitor new members’ understanding of its procedures, and update its marketing materials accordingly?

8.    Delegation of Members’ Rights and Responsibilities (RR 8)

• If the plan delegates member services activities to a third party, is the decision-making process—including the responsibilities of the plan and delegated party—clearly documented?
• Does the plan evaluate and approve the delegated party’s ability to perform these services beforehand, and on a regular basis?