Does your family know what type of care you want in the event of a serious illness? What if you’re badly
injured in an accident? To prevent your family from facing hard life-and-death choices without your
guidance, write your wishes in an advance directive. The durable power of attorney for health care
(DPAHC) is a form of the advance directive. You can use this form to tell your doctors and family whom
you want to make health care choices for you if you can’t do it yourself.
Here is all you need to know:
• Anyone 18 and older should have a plan
• You can change your representative at any time
• Have a talk with your doctor and family members about your wishes
• Make someone a representative now so that everyone knows what kind of care you do or do not
wish to receive in the future
• Get a copy of Know Your Medical Rights by calling Customer Service or go to
• Give a copy of your DPAHC to your representative and your doctor
Making Sure Everyone Gets Care
It is our mission to enhance the health and well-being of the lives we touch. This means making sure you
get great care. To that end, we offer health fairs and other community outreach programs to promote
health, wellness and service.
You can help us meet member needs by letting us know more about you. We, and your doctors, may ask you
questions about your race and ethnicity. We may ask what languages you speak. Getting this information is
the first step in making sure we have the programs in place to meet all of our members’ needs.
Giving us this information is voluntary. It isn’t used to decide your coverage or cost sharing or claims
payments. It isn’t used to discriminate against you in any way.
We appreciate you helping us improve and expand our services. When we work together, we can help
improve the quality of life for our entire membership.
Rights and Responsibilities
As a member, you have the right to:
• Get complete information about your health plan. This means our services, practitioners and
doctors and your rights and responsibilities.
• Get private, thoughtful and respectful care. Care does not take nationality, race, creed, color,
age, economic rank, sex or lifestyle into consideration.
• Work with your doctors in making choices about your health care. Talk with your doctor to fully
understand your illness or treatment.
• Have a candid talk with your doctors about your treatment alternatives, no matter the cost or
• Receive all the information you need to give informed, legally needed consent before the start of
any procedure or treatment. This includes an explanation of procedures and any risks.
• Voice a complaint or appeal about us and our services.
• Make recommendations about our members’ rights and responsibilities policies.
• Be told about affiliated providers available for medical care.
• Expect us to make a reasonable answer to your requests.
• Get prompt care in an emergency.
As a member, you have the responsibility to:
• Make your medical history and symptoms known before and during the course of treatment.
• Tell us of any changes in important membership information.
• Tell your doctor of any unexpected changes in your health.
• Follow the plans and directions for care that you agreed on with your providers.
• Understand your health problems.
• Take part in creating mutually agreed-upon treatment goals, to the degree possible.
• Cooperate in full with your providers.
• Understand our procedures and use the plan in the right way.
• Respect the rights of other patients and members.
This ASO plan is administered by Alliance Health and Life Insurance Company. Alliance Health and Life
Insurance Company assumes no financial risk on self-funded claims. Plan sponsor funds covered claims.