Health Plan of San Joaquin | Focus Your Health | Winter 2021-2022

NondiscriminationNotice 888.936.PLAN (7526), TTY/TDD 711 By fax: 209.942.6355 • In person: Visit your doctor's office or Health Plan of San Joaquin and say you want to file a grievance. • Electronically: Visit Health Plan of San Joaquin's website at www.hpsj.com If you need help filing a grievance, a Customer Service Representative can help you. OFFICE OF CIVIL RIGHTS - CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES You can also file a civil rights complaint with the California Department of Health Care Services, Office of Civil Rights by phone, in writing, or electronically: • By phone: Call 916.440.7370 . If you cannot speak or hear well, please call 711 (Telecommunications Relay Service). • In writing: Fill out a complaint form or send a letter to: Deputy Director, Office of Civil Rights Department of Health Care Services Office of Civil Rights P.O. Box 997413, MS 0009 Sacramento, CA 95899-7413 Complaint forms are available at http:www.dhcs.ca.gov/Pages/Language_Access.aspx • Electronically: Send an email to CivilRights@dhcs.ca.gov OFFICE OF CIVIL RIGHTS - U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES If you believe you have been discriminated against on the bases of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights by phone, in writing, by phone or electronically: • By phone: Call 1.800.368.1019 . If you cannot speak or hear well, please call TTY/TDD 1.800.537.7697 . • In writing: Fill out a complaint form or send a letter to: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at http:www.hhs.gov/ocr/office/file/index.html. • Electronically: Visit the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. Call customer service toll free at 888.936.PLAN(7526)TTY/TDD711. Health Plan of San Joaquin is open Monday -Friday, 8:00 a.m. - 5:00 p.m. Visit online at www.hpsj.com R-05102021 • By phone: Contact between Monday - Friday, 8:00 a.m. - 5:00 p.m. by calling 888.936.7526. Or, if you cannot hear or speak well, please call TTY/TDD 711. • In writing: Fill out a complaint form or write a letter and send it to: Health Plan of San Joaquin Attn: Grievance and Appeals Department 7551 S. Manthey Road French Camp, CA 95231 —Continued from page 7