Members Rights & Responsibilities

NHI will work better if you use the services in a responsible manner:

Do what you can to protect your own health, and follow advice on a healthy lifestyle.

As much as possible, care for yourself when you can (for example, you can treat yourself for minor ailments such as coughs, colds and sore throats).

Listen carefully to advice on your treatment and medication and follow this advice. Tell the doctor about any condition you may already have or treatments you are already taking.

Treat NHI staff, fellow patients, care givers and visitors politely, and with respect. NHI will not accept violence, racial, sexual or verbal harassment. Any such misconduct will be documented and can result in denial of services.

Keep your appointment or let the General Practitioner (GP) or clinic know as soon as possible if you cannot make it. Book your routine appointments ahead of time.

Use this Guide to help you find the services you need.

Use medications, labs and imaging services wisely, only at the request of a physician, and only when needed.

1. Obtain information on the list of physicians who practice within the PCP.
2. Access primary and preventive care offered at the PCP.
3. Transfer from one PCP to another in the geographic zone if there is change of address or dissatisfaction with services rendered. This is permitted only once a year. This is subject to availability of space at the clinic you wish to transfer to.
4. Obtain services from approved support service providers.
5. Obtain information from PCP on how to schedule appointments, what are the working hours and contact information.
6. Receive treatment with respect, privacy and dignity.
7. Maintain medical records confidentiality, unless mandated by law or with your prior approval.
8. Discuss with the physician a member’s own medical condition and all care alternatives including potential risks and benefits even if a care option in not covered by NHI.
9. Be aware that a health provider has the right to complain about a patient’s misconduct.
10. Obtain information on the package of services covered by NHI including the exclusions and limitations.
11. Obtain information about co-payments and consultation fees that must be paid where applicable.
12. Be informed on how to file a complaint, grievance to the PCP and NHI if necessary.
13. Receive prompt reply when asking questions or requesting information from the NHI providers.

1. Register with your designated PCP in the corresponding geographic zone.
2. Posses a valid social security card for self and other family members.
3. Present the card at every clinic visit or when accessing any service covered by NHI.
4. Be responsible for securing yours and or other family member’s Social Security Card and prevent its damage or loss.
5. Comply with Social Security’s policies for obtaining or replacing damaged or lost Social Security Cards.
6. Assist the physician in decisions pertaining to member’s own health care.
7. Inform the PCP or physician if you do not understand the treatment received and ask if you still do not understand how to care for your illness.
8. Follow the directions and advice that you and your physician jointly agreed on.
9. Inform your PCP provider promptly when you have unexpected problems or symptoms.
10. Make sure you have the appropriate authorization for certain services including inpatient hospitalization and out- of- geographic zone treatment prior to accessing these services
11. Schedule and keep appointments with the PCP.
12. Understand that participating PCPs, physicians and support service providers are not employees of NHI and as such are not controlled by NHI. Therefore, NHI is not responsible for any misconduct or malpractice resulting from services rendered.
13. Understand that NHI pays providers for services rendered and does not directly manage those funds issued. This is the sole responsibility of the provider.
14. Understand that in order to receive any services under NHI, a member must always present his/her valid Social Security Card as well as those of their family members. This is a pre-requisite and absolutely no exceptions are to be made.
15. A member is required to pay co-payments where applicable.
16. Follow the complaint and grievance procedures if you need to do so.
17. Give correct and complete information to the health care providers who are offering services such as pre- existing conditions, allergies and medications taken that may assist in proper management of your health condition.
18. Treat all health providers and their staff with respect.
19. Do not be involved in dishonest activities directed at making false claims that result in personal gains to any of the providers.
20. Understand that the basic package of health services can be increased or reduced and modified accordingly.
21. Report to NHI the intent to leave the country or the move to another Geographic zone according to procedures.
22. Report the death of a family member to NHI.