Your Responsibilities as an Oregon Health Plan (OHP) Member

When you applied for OHP, you agreed to give Oregon Department of Human Services and Oregon Health Authority true, correct and accurate information when asked for it. This page tells you more about other things you need to do as an OHP member.

OHP Rights and Responsibilities

These rules list the rights and responsibilities you have as an OHP member:

410-120-1855 – For all OHP members.
410-141-3590 – For all OHP members in coordinated care organization (CCO).
410-141-3810 – Explains when members can ask for disenrollment from a CCO, and how to do this.

Your Responsibilities

As an OHP member, you agree to:

Find a doctor and dentist or other provider you can work with and tell that provider about your health
Treat providers and their staff with the same respect you want
Bring your medical ID cards to appointments (Oregon Health I.D, CCO ID, Medicare ID cards, private insurance)
Tell the receptionist you have OHP and any other health insurance
Tell the staff if you were hurt in an accident
Be on time for appointments
Call your provider at least one day before if you can’t make it to an appointment
Have yearly checkups, wellness visits and other services to prevent illness and keep you healthy
Follow your providers’ and pharmacists’ directions, or ask for another choice
Be honest with your providers to get the best service

Report changes as soon as possible.

To report changes, you can call 800-699-9075 (TTY 711).
You can also report changes in person, by fax, or by mail.

Changes may be to your name, address, household, income or immigration status. Learn about the types of changes to report and how to report them.

Members must report all health coverage resources. This is to make sure OHP only pays after other resources have paid.

Report personal injury or accidents: Report current personal injury claims or your intent to file a claim at www.reportinjury.org. Also report the injury to your CCO.
Report other health coverage: Report any other health coverage, such as private health insurance, at www.reportTPL.org .

If OHP pays for services that another resource should have covered, the Office of Accuracy and Payment Recovery will recover those payments.

When you applied, you agreed that any other medical payments you receive would go to the state. This is called “assignment of rights.” When the state collects these other payments, it is called “payment recovery.”

The state will keep the money it collects from other payers. This money helps other people get the care and services they need. Learn more about payment recovery.

Read all letters that ODHS/OHA and your CCO send you. If you have problems reading the information, call your CCO or OHP Client Services and ask for help.

If you think someone is misusing Medicaid programs and benefits, report it right away. You can call, email or write us.

Client fraud is when a member lies or does not share correct information so that they can qualify for Medicaid benefits. It can also be when someone uses another person's ID card to get OHP benefits. Find examples on Oregon's fraud reporting website.

Provider fraud can be many things. It includes billing Medicaid for services that the member did not receive, did not ask for, or were not medically necessary. Find examples on Oregon's Medicaid fraud website.