/ / /

Advance Directives

Advance directives are documents that allow you to make your wishes about end-of-life care known ahead of time, including who you
want to make healthcare decisions for you, should you ever become unable to speak for yourself.

picture_as_pdf Utah Advance Directives Form

picture_as_pdf Utah Formularios de Directivas Anticipadas

picture_as_pdf Idaho Advance Directives Form

picture_as_pdf Idaho Formularios de Directivas Anticipadas

picture_as_pdf Nevada Advance Directives Form

picture_as_pdf Nevada Formularios de Directivas Anticipadas

Advance directives include the following properly executed documents:

Living Will
Durable Power of Attorney for Healthcare
Written statements expressing a patient's wishes regarding treatment and/or end-of-life care
Patient statements regarding treatment and/or end of-life care documented in the medical record

It is important to understand the options available to you for advance directives and your rights under state law. Select Health and our
network of hospitals and providers are required to comply with state law and cannot refuse care or otherwise discriminate against you
based on whether or not you have a properly executed advance directive. If you don't have advance directives on file, this information will
be provided to you upon request.

Who should have advanced directives?

We encourage you to discuss your wishes with family members and healthcare providers, and to complete advance directives prior to receiving
care or being hospitalized. When you provide a copy of your advance directives to provider, they are required to keep the
documents in your medical record and refer to them when determining a course of treatment. You may change your advance directives
simply by giving your provider a new Living Will and Durable Power of Attorney for Healthcare. To cancel or revoke your advance directives,
you should communicate your wishes in writing to your healthcare provider.

Where can I find additional information?

Ensuring that you understand your rights with regard to advance directives is very important to us. To help you, our staff has received
special training and education about the policies and procedures for advance directives. We also provide related community education.
For more information about advance directives, please call or visit the appropriate phone number or website listed below:

Intermountain Health: toll-free 800-442-4845 or advance planning.
St. Luke's Health System: 208-381-2616 or advance directives.

If you have given your healthcare provider a signed advance directive, and you believe your healthcare provider has not followed your instructions,
you may file a complaint

Utah

link Utah State Department of Health

link Utah Department of Public Licensure

Idaho

link The Office of the Attorney General for the State of Idaho

Nevada

link Nevada Secretary of State

Ask your nurse or doctor for more information about advance directives

Medicare Disclaimers

Select Health is an HMO, PPO, SNP plan sponsor with a Medicare contract. Enrollment in Select Health Medicare depends on contract renewal. The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed. You are eligible to enroll if you are entitled to Medicare Part A and enrolled in Medicare Part B and you live in the service area. With some exceptions you can only enroll during certain times of the year. Medicare beneficiaries may also enroll in Select Health Medicare through the CMS Medicare Online Enrollment Center, located at www.medicare.gov. This information is not a complete description of benefits. Call for more information. Other providers/pharmacies/physicians are available in our network. For accommodation of persons with special needs at sales meetings call Member Services at Toll-Free: 855-442-9900 (TTY Users: 711) All Medicare Advantage plans and Medicare Part D plans agree to stay in the program for a full calendar year at a time. Plan benefits and cost-sharing may change from calendar year to calendar year. Each year, plans can decide whether to continue to participate with Medicare Advantage or Medicare Part D. A plan may continue in their entire service area (geographic area where the plan accepts members) or choose to continue only in certain areas. Also, Medicare may decide to end a contract with a plan. Even if your Medicare Advantage plan or Medicare Part D plan leaves the program, you will not lose Medicare coverage. If a plan decides not to continue for an additional calendar year, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area. This site uses Adobe Acrobat to distribute many of our documents. Every year, Medicare evaluates plans based on a 5-star rating system. SELECT HEALTH, SELECT HEALTH MEDICARE, INTERMOUNTAIN HEALTH, and the Select Health and the Intermountain Health logos are registered trademarks of Select Health, Inc. or Intermountain Health, Inc., and may not be used except with written permission of the respective owner.

Advance Directives

Who should have advanced directives?

Where can I find additional information?

Important Links

Helpful Links

Notices

Contact Us

Medicare Disclaimers

Advance Directives

Who should have advanced directives?

Where can I find additional information?

Important Links

Helpful Links

Notices

Contact Us

Medicare Disclaimers

Make a Premium Payment