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Member Rights and Responsibilities
As a member of the World Trade Center (WTC) Health Program, you have many rights. You also have certain responsibilities to help ensure you get the most out of your membership.
Your Rights as a WTC Health Program Member
Privacy and Confidentiality
Your personal and medical information will be handled in a manner that preserves and protects your confidentiality. This includes, but is not limited to, the maintenance of medical records in a secure environment and the education of Program staff on confidentiality.
The Program will not release medical information without authorization, except as required or permitted by law to administer benefits, comply with government requirements, or if you consent to participate in research or education.
Access to Treatment
You have the right to receive medically necessary treatment for a WTC-related health condition(s) if the condition(s) is certified by the Program. You also have the right to be informed about the risks and benefits of treatment and to refuse care.
Receive Considerate, Respectful Care
The Program strives to treat all members equally and with respect and dignity, regardless of race, religion, sex, sexual orientation, national origin, age, disability, or income.
Appeal Decisions
You have a right to appeal certain Program decisions, including an enrollment denial, disenrollment, certification denial, decertification, and treatment denial. However, you cannot appeal decisions based solely on disagreement with Program policy or regulations or requirements of the James Zadroga 9/11 Health and Compensation Act, as amended.
Voice Complaints or Grievances
You have the right to voice complaints or concerns with the Program. You have the right to receive a prompt and fair review of those concerns.
Your Responsibilities as a WTC Health Program Member
Know the Extent and Limitations of Program Services
There are laws and regulations that guide the Program’s limited health benefits. The Member Handbook and Program website include detailed information for members to know more about Program benefits and services.
Keep Appointments
You are responsible for keeping your appointments. If you are unable to keep your appointment, notify your clinic or the Nationwide Provider Network at least 24 hours before your appointment so that your appointment time can be given to another member.
Provide Accurate and Complete Information
You are responsible for providing accurate and complete medical information to the Program. This includes submitting appropriate signed medical release forms and, for Survivors, providing primary health insurance information to Program providers and clinics.
Maintain Necessary Minimum Essential Coverage
All members are responsible for maintaining minimum essential coverage (primary health insurance requirement). For Survivors, treatment benefits under the Program will be coordinated with their primary health insurance plan and the Program.
Follow Care Requirements
Treatment of your certified WTC-related health condition(s) will be provided at no out-of-pocket cost when care adheres to Program requirements. These requirements include that the care provider is affiliated with the Program and the services are appropriately authorized by the necessary Program provider or staff.
Show Consideration and Respect
You are responsible for always showing consideration and respect to Program providers and staff. Disruptive, abusive, or threatening behavior will not be tolerated.
The WTC Health Program believes that all individuals have a right to a safe working environment. Disruptive or abusive behavior by a WTC Health Program applicant or member at or directed to a facility or personnel affiliated with the Program (e.g., a Clinical Center of Excellence, the Nationwide Provider Network, providers, or staff) will not be tolerated.
These types of behavior include, but are not limited to:
- Acts of violence or threats against staff or other patients, including verbal or physical abuse;
- Rude or vulgar language, including cursing or shouting;
- Throwing or striking objects;
- Harassing or stalking;
- Concealing or using a weapon; and
- Engaging in criminal behavior.
Depending on the particular circumstances, members who engage in such behaviors:
- May have their care suspended by their Clinical Center of Excellence or Nationwide Provider Network provider;
- May be required to sign a behavioral agreement outlining what will be expected of them in order to receive care from their provider;
- May be required to transfer to another Clinical Center of Excellence or Nationwide Provider Network provider; or
- May be subject to other appropriate actions, including involvement of law enforcement authorities as necessary.
The Program strives to provide high-quality, compassionate care for members’ WTC-related health needs. Disruptive or abusive behavior, however, may impact the Program’s ability to provide benefits in a timely manner.
More information on your member rights and responsibilities is available in the WTC Health Program Member Handbook.