Member Rights FAQs

WHAT ARE MY RIGHTS AS A MEMBER?

It is important to us that you understand your rights as a UnitedAg member:

  • You have the right to receive information about UnitedAg, its services, its providers
  • You have the right to appeal any decision made by UnitedAg and to receive a response within 30 days. You have 180 days to appeal an adverse determination or appeal of a denied claim. Please send your appeal to: UnitedAg, 54 Corporate Park, Irvine, CA 92606. (Please refer to the UnitedAg Summary Plan Description: unitedag.org/spd)

As a participant in UABT you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA, 29 U.S.C. 1001 et seq.). ERISA specifies that all Plan Participants shall be entitled to:

  • Examine, without charge, at the Plan Administrator’s office, all Plan Documents and copies of all documents filed by the Plan with the U.S. Department of Labor, such as detailed annual reports and Plan descriptions.
  • Obtain copies of all Plan Documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies.
  • Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this Summary Annual Report.

Read more about this topic in the Member Rights section of the Member Guide.

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WHAT ARE MY PRIVACY RIGHTS?

As a member of UnitedAg, you have the right to confidentiality. Confidentiality means you have the right to have your medical information kept private. This information cannot be released without your permission. At UnitedAg, we take confidentiality very seriously.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations restrict the UnitedAg’s ability to use and disclose protected health information. UnitedAg’s privacy policy applies to UnitedAg, its Board of Trustees, Plan Administrator, employees, service representatives and any third party that assists in the administration of UnitedAg claims.

Read more about this topic in the Notice of Privacy section of the Member Guide.

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WHAT ARE MY RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS?

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or must pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than innetwork costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

Read more about this topic in the Rights and Protections Against Surprise Medical Bills section of the Member Guide.

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