Health Plan of San Joaquin | Focus Your Health | Fall 2022

NondiscriminationNotice 5 ( 'LVFULPLQDWLRQ LV DJDLQVW WKH ODZ +HDOWK 3ODQ RI 6DQ -RDTXLQ IROORZV 6WDWH DQG )HGHUDO FLYLO ULJKWV ODZV +HDOWK 3ODQ RI 6DQ -RDTXLQ GRHV QRW XQODZIXOO\ GLVFULPLQDWH H[FOXGH SHRSOH RU WUHDW WKHP GLIIHUHQWO\ EHFDXVH RI VH[ UDFH FRORU UHOLJLRQ DQFHVWU\ QDWLRQDO RULJLQ HWKQLF JURXS LGHQWLILFDWLRQ DJH PHQWDO GLVDELOLW\ SK\VLFDO GLVDELOLW\ PHGLFDO FRQGLWLRQ JHQHWLF LQIRUPDWLRQ PDULWDO VWDWXV JHQGHU JHQGHU LGHQWLW\ RU VH[XDO RULHQWDWLRQ +HDOWK 3ODQ RI 6DQ -RDTXLQ SURYLGHV x )UHH DLGV DQG VHUYLFHV WR SHRSOH ZLWK GLVDELOLWLHV WR KHOS WKHP FRPPXQLFDWH EHWWHU VXFK DV ✓ 4XDOLILHG VLJQ ODQJXDJH LQWHUSUHWHUV ✓ :ULWWHQ LQIRUPDWLRQ LQ RWKHU IRUPDWV ODUJH SULQW DXGLR DFFHVVLEOH HOHFWURQLF IRUPDWV DQG RWKHU IRUPDWV x )UHH ODQJXDJH VHUYLFHV WR SHRSOH ZKRVH SULPDU\ ODQJXDJH LV QRW (QJOLVK VXFK DV ✓ 4XDOLILHG LQWHUSUHWHUV ✓ ,QIRUPDWLRQ ZULWWHQ LQ RWKHU ODQJXDJHV ,I \RX QHHG WKHVH VHUYLFHV FRQWDFW +HDOWK 3ODQ RI 6DQ -RDTXLQ EHWZHHQ 0RQGD\ )ULGD\ D P S P E\ FDOOLQJ 888.936.7526 ,I \RX FDQQRW KHDU RU VSHDN ZHOO SOHDVH FDOO 77< 7'' WR XVH WKH &DOLIRUQLD 5HOD\ 6HUYLFH 8SRQ UHTXHVW WKLV GRFXPHQW FDQ EH PDGH DYDLODEOH WR \RX LQ EUDLOOH ODUJH SULQW DXGLR DQG DFFHVVLEOH HOHFWURQLF IRUPDW 7R REWDLQ D FRS\ LQ RQH RI WKHVH DOWHUQDWLYH IRUPDWV SOHDVH FDOO RU ZULWH WR Health Plan of San Joaquin 7751 South Manthey Road, French Camp, CA 95231 888.936.PLAN (7526), TTY/TDD 711 HOW TO FILE A GR,EVANCE ,I \RX EHOLHYH WKDW +HDOWK 3ODQ RI 6DQ -RDTXLQ KDV IDLOHG WR SURYLGH WKHVH VHUYLFHV RU XQODZIXOO\ GLVFULPLQDWHG LQ DQRWKHU ZD\ RQ WKH EDVLV RI VH[ UDFH FRORU UHOLJLRQ DQFHVWU\ QDWLRQDO RULJLQ HWKQLF JURXS LGHQWLILFDWLRQ DJH PHQWDO GLVDELOLW\ SK\VLFDO GLVDELOLW\ PHGLFDO FRQGLWLRQ JHQHWLF LQIRUPDWLRQ PDULWDO VWDWXV JHQGHU JHQGHU LGHQWLW\ RU VH[XDO RULHQWDWLRQ \RX FDQ ILOH D JULHYDQFH ZLWK +HDOWK 3ODQ RI 6DQ -RDTXLQ¶V &LYLO 5LJKWV &RRUGLQDWRU WKH &KLHI &RPSOLDQFH 2IILFHU <RX FDQ ILOH D JULHYDQFH LQ ZULWLQJ LQ SHUVRQ RU HOHFWURQLFDOO\ x %\ SKRQH &RQWDFW EHWZHHQ 0RQGD\ )ULGD\ D P S P E\ FDOOLQJ 888.936.7526 2U LI \RX FDQQRW KHDU RU VSHDN ZHOO SOHDVH FDOO 77< 7'' x ,Q ZULWLQJ )LOO RXW D FRPSODLQW IRUP RU ZULWH D OHWWHU DQG VHQG LW WR Health Plan of San Joaquin Attn: Grievance and Appeals Department 7551 S. Manthey Road, French Camp, CA 95231 888.936.PLAN (7526), TTY/TDD 711 %\ ID[

RkJQdWJsaXNoZXIy NzIxMDA=