Our Mission, Values and Commitment

Mission

To serve as a partner to our clients, providing innovative, long-term healthcare solutions through our products and services.

Vision

Carolina Care Plan strives to help make healthcare possible.

Values

Best Service

Our policyholders, members, brokers, benefit consultants and group benefit managers are our customers. We recognize that each employee who has direct contact with our customers is our key internal client and will receive prompt and adequate support from the entire organization to meet our customers' needs. We will maintain and build upon our tradition of fast, accurate claims payment and excellent customer service. We will design and manage the customer health benefits, healthcare provider relationships and management systems so as to facilitate and support quality, efficient and effective healthcare.

Best Products

We are committed to producing superior value for our members by assuring access to quality healthcare providers who offer appropriate care at an affordable price. We are committed to maintaining and building our volume of sales to accommodate risk and spread overhead expense. We will protect our policyholders by operating efficiently and profitably, thereby assuring adequate and well-managed financial reserves for future claims.

Responsible Citizen

We will set an example as an excellent community and corporate citizen. Our relationships and interactions with our customers, employees, healthcare providers, governmental agencies and competitors will exhibit the highest professional standard of conduct. We will actively support and participate in organizations that serve to strengthen and improve the health and well being of the communities we serve.

Employee Development

We recognize that our employees are our most important asset in meeting the needs of our customers. We will foster a workplace environment that recognizes rewards and empowers employees for excellence in service, quality and continuous improvement. We will provide opportunities for personal and professional development and growth of our employees.

Commitment to Our Members

Carolina Care Plan recognizes that the ultimate value of health insurance is the peace of mind that comes in knowing you have access to quality healthcare practitioners and that you are protected from the potentially catastrophic costs of healthcare.

As a member of Carolina Care Plan, you are assured that through our insurance plans and services you will have access to excellent healthcare practitioners, excellent hospitals, and other facilities, as well as accurate administration of policies and claims.

We will seek to work with healthcare practitioners and facilities recognized for the quality of their medical services and clinical outcomes and to assure freedom of choice for the consumer.

We will assure sound, responsible financial management so that our policies are backed up by strong financial reserves to guarantee that future costs are planned and adequately covered.

Bill of Rights

Carolina Care Plan Members have the right to:

• Choose among quality healthcare practitioners, hospitals, pharmacies and other facilities within a network and get covered services and prescriptions filled (if applicable) within a reasonable period of time. Women have the right to see a women's health specialist without referral.
• Emergency medical care as defined by a prudent layperson.
• Information about their healthcare practitioners, benefits, financial liability, health promotion, illness prevention, advanced directives, and treatment options regardless of cost or benefit coverage, in a language they understand.
• Courteous and respectful care and service in a culturally sensitive way and not be discriminated against based on race, ethnicity, national origin, religion, sex, age and mental or physical disability.
• Privacy and confidentiality in the use of their personal and medical information and records and the option to request confidential communications.
• Request and receive a copy of their protected health information and to amend their protected health information for corrections and / or omissions.
• Request an accounting of protected health information disclosures outside of routine uses, to complain about privacy violations, and to receive a Notice of Privacy Practices.
• Authorize or deny release of personal health information beyond use for treatment, payment, or health care operations.
• Exercise all federal and state rights, including rights under the Health Information Portability and Accountability Act (HIPAA), without fear of retaliation or condition of payment. Members will not be required to waive their rights in order to be provided benefits.
• Be informed and responsible participants with practitioners in decisions affecting their health and/or have a representative facilitate healthcare when they are unable to do so.
• Refuse medical treatment.
• Prompt accurate payment of their claims in accordance with the terms of their policies.
• Prompt and courteous response to concerns, questions, complaints or grievances, which may arise in the course of purchasing and utilizing our insurance plans and services, and to appeal any decision.
• If covered by an insured program, request a review by the department of insurance or other independent review entity as appropriate if Carolina Care Plan denies, reduces or discontinues coverage for a healthcare service because the company determines that the service was not covered as part of the health plan or not medically necessary.
• Ask and be informed about business relationships between Carolina Care Plan and the practitioners, hospitals, and other healthcare providers and facilities that may influence members’ treatment and care.
• Access a full range of care and to receive the right care at the right time and place.
• Make recommendations regarding the members’ rights and responsibilities policies.

Carolina Care Plan Members have the responsibility to:

• Cooperate with their healthcare practitioners in following the prescribed care plan to which they have agreed.
• Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
• Promptly pay appropriate co-payments, coinsurance, and deductibles.
• Provide Carolina Care Plan and healthcare practitioners the information needed to provide proper care and to appropriately administer claims, payment, and coordination with other payers.
• Choose a primary care physician to coordinate medical services if required by their insurance plan.