tóm lược quyền lợi năm 2018 - health net€¦ · nếu quý vị có điều gì thắc...

H3237_18_002_SB_VIE_Accepted_09042017

Tm lc quyn li nm 2018Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)

San Diego County, CA

Nu qu v c iu g thc mc, vui lng lin lc vi Health Net Cal MediConnect theo s 1-855-464-3572 (TTY: 711) t 8 gi sng n 8 gi ti, th Hai n th Su. Sau gi lm vic, vo cui tun v cc ngy l, qu v c th li tin nhn. Chng ti s gi li cho qu v vo ngy lm vic tip theo. Cuc gi ny min ph. bit thm thng tin, vui lng truy cp trang web www.healthnet.com/calmediconnect.

?

Health Net Cal MediConnect Tm lc quyn li

y l bn tm lc cc dch v chm sc sc khe c Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) i th vo ngy 1 thng 1, 2018. y ch l bn tm lc. Xin qu v vui lng xem S tay hi vin bit danh sch y cc quyn li.

Health Net Community Solutions, Inc. l mt chng trnh bo him sc khe c hp ng vi c Medicare v Medi-Cal cung cp quyn li ca c hai chng trnh ny cho ngi ghi danh trong chng trnh. Chng trnh ny dnh cho nhng ngi c c chng trnh Medicare v Medi-Cal.

Theo Health Net Cal MediConnect, qu v s c cung cp cc dch v ca Medicare v Medi-Cal trong cng mt chng trnh bo him sc khe. iu phi vin dch v chm sc thuc Health Net Cal MediConnect s gip qun l cc nhu cu v chm sc sc khe ca qu v.

y khng phi l mt danh sch y . Thng tin v quyn li bo him trnh by trong ti liu ny ch l thng tin tm lc v khng m t y cc quyn li bo him. bit thm thng tin, vui lng lin lac vi chng trnh hoc xem S tay hi vin.

Gii han, tin ng tr v nhng iu khon han ch c th p dng. bit thm thng tin, vui lng gi Ban Phc v Hi vin ca HealthNet Cal MediConnect hoc xem S tay hi vin ca Health Net Cal MediConnect.

Danh sch thuc c i th v/hoc h thng nh thuc v nh cung cp dch v chm sc sc khe c th thay i trong sut nm. Chng ti s gi cho qu v thng bo trc khi chng ti thc hin mt thay i nh hng n qu v.

Cc quyn li v/hoc tin ng tr c th thay i vo ngy 1 thng 1 hng nm. Tin ng tr cho thuc theo toa c th thay i ty theo mc Tr gip ph tri qu v nhn c. Vui lng lin lac vi chng trnh

bit thm chi tit. Quy v c th nhn ti liu ny min phi bng cc nh dang khc, chng han nh bn in c ln, ch ni braille hoc m thanh. Hy gi

1-855-464-3572 (TTY: 711) t 8 gi sng n 8 gi ti, th Hai n th Su. Sau gi lm vic, vo cui tun v cc ngy l, quy v c th lai tin nhn. Chng ti s gi lai cho quy v vo ngy lm vic tip theo. Cuc gi ny min phi.

Nu qu v mun Health Net Cal MediConnect gi cho qu v ti liu hin hnh dnh cho hi vin bng cc nh dang khc, nh ch ni braille hoc bn in kh ln, hoc bng ngn ng khc khng phi ting Anh, vui lng lin h Ban Phc v Hi vin. Hy cho Ban Phc v Hi vin bit rng qu v mun t ra mt yu cu c nh i vi vic nhn ti liu bng nh dang hoc ngn ng khc.

!

2

3

Health Net Cal MediConnect: Tm lc quyn li


?

3

If you do not speak English, language assistance services, free of charge, are available to you. Call 1-855-464-3572 (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can leave a message. Your call will be returnedwithin the next business day. The call is free.

. TTY: 711) 1-855-464-3572) 8:00 8:00 . . .



?

4

Bng sau y trnh by nhng cu hi thng gp.Cc cu hi thng gp (vit tt trong ting Anh l FAQ)

Gii p

Chng trnh Cal MediConnect l chng trnh g?

Cal MediConnect Plan l mt t chc gm c cc bc s, bnh vin, nh thuc, cc nh cung cp dch v di hn v nhng nh cung cp dch v chm sc sc khe khc. T chc cng c cc iu phi vin dch v chm sc sc khe gip qu v qun l tt c cc dch v v cc nh cung cp dch v chm sc sc khe ca mnh. H cng nhau lm vic cung cp cho qu v dch v chm sc qu v cn. Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) l Cal MediConnect Plan cung cp quyn li ca Medi-Cal v Medicare cho nhng ngi ghi danh.

iu phi vin dch v chm sc ca Health Net Cal MediConnect l ai?

iu phi vin dch v chm sc ca Health Net Cal MediConnect l nhn vin chnh qu v lin lc. Nhn vin ny gip qun l tt c cc dch v v cc nh cung cp dch v chm sc sc khe ca qu v, ng thi bo m cho qu v nhn c nhng g qu v cn.

Cc dch v v h tr di hn (Long-Term Services and Supports, LTSS) l g?

LTSS l nhng dch v dnh cho ngi hng cn c gip trong nhng sinh hot thng ngy nh tm ra, thay qun o, nu n v dng thuc. Phn ln nhng dch v ny c cung cp ngay ti nh hoc trong cng ng ca qu v nhng cng c th c cung cp ti vin iu dng hay trong bnh vin.LTSS bao gm cc chng trnh sau: Chng trnh dch v a dng cho ngi cao nin (MSSP), Dch v phc v ngi ln qua t chc cng ng (Community-Based Adult Services, CBAS), v chm sc iu ng chuyn mn di hn c cung cp bi cc C s iu dng (Nursing Facilities, NF).

Qu v c c nhn cng cc quyn li ca Medicare v Medi-Cal trong HealthNet Cal MediConnect nh hin nay qu v c nhn khng?

Qu v s c nhn hu ht cc quyn li ca Medicare v Medi-Cal c i th trc tip t Health Net Cal MediConnect. Qu v s lm vic vi mt nhm cc nh cung cp dch v chm sc sc khe v nhng ngi ny s xc nh xem nhng dch v no p ng nhu cu ca qu v tt nht. iu ny c ngha l mt s dch v m hin nay qu v ang c cung cp c th s thay i. Khi qu v ghi danh vo Health Net Cal MediConnect, qu v v nhm chm sc ca qu v s cng nhau lm vic thit lp mt K hoch chm sc c nhn cho qu v nhm p ng cc nhu cu sc khe v nhu cu cn c h tr ca qu v theo ng mc tiu v mun ca qu v. Ngoi ra, nu qu v ang dng nhng loi thuc theo toa trong chng trnh Medicare Phn D m Health Net Cal MediConnect thng khng i th, qu v s c cp mt lng thuc tm thi v chng ti s gip cho qu v chuyn sang mt loi thuc khc hoc gip qu v c hng trng hp ngoi l Health Net Cal MediConnect i th cho thuc ny nu cn thit v mt y t.

5



?

Cc cu hi thng gp (vit tt trong ting Anh l FAQ)

Gii p

Qu v c c n thm khm cng bc s m hin nay qu v ang thm khm khng?

Thng th c. Nu cc nh cung cp dch v chm sc sc khe ca qu v (k c bc s v nh thuc) c lm vic vi Health Net Cal MediConnect v c hp ng vi chng ti th qu v c th tip tc n thm khm h. Cc nh cung cp dch v chm sc sc khe c hp ng vi chng ti c xem l "trong h thng." Qu v phi dng cc nh cung cp dch v chm sc sc khe trong h thng ca Health Net Cal MediConnect. Nu qu v cn c chm sc cp cu hay khn cp, hoc qu v cn c cp dch v thm tch ngoi khu vc, qu v c th dng cc nh cung cp dch v chm sc sc khe ngoi chng trnh ca Health Net Cal MediConnect. bit thm thng tin v vic thm khm cc nh cung cp dch v chm sc sc khe ngoi h thng ca Health Net Cal MediConnect, vui lng gi Ban Phc v Hi vin hoc xem S tay hi vin ca Health Net Cal MediConnect. bit xem bc s ca qu v c trong h thng ca chng trnh hay khng, vui lng gi Ban Phc v Hi vin hoc xem Danh mc cc nh cung cp dch v chm sc sc khe v nh thuc ca Health Net Cal MediConnect. Nu qu v mi vo Health Net Cal MediConnect, chng ti s cng qu v thit lp mt K hoch chm sc c nhn nhm p ng cc nhu cu ca qu v. Qu v c th tip tc thm khm nhng bc s hin nay qu v ang thm khm trong ti a 12 thng nu nhng bc s ny cung cp cho qu v nhng dch v c Medicare v Medi-Cal i th, v p ng mt s iu kin. Vui lng lin h Ban Phc v Hi vin ca Cal MediConnect theo s 1-855-464-3572 (TTY: 711), t th Hai n ht th Su, 8:00 sng n 8:00 ti v cho h bit qu v mun yu cu c chm sc lin tc.

Nu qu v cn dch v m khng c nh cung cp dch v chm sc sc kho no trong h thng ca HealthNet Cal MediConnect cung cp th sao?

a s cc dch v s c cc nh cung cp dch v chm sc sc khe trong h thng ca chng ti cung cp. Nu qu v cn mt dch v m dch v khng c cung cp trong h thng ca chng ti, Health Net Cal MediConnect s tr chi ph cho nh cung cp dch v khng thuc h thng.

Cc dch v ca Health Net Cal MediConnect c cung cp u?

Khu vc dch v cho chng trnh ny bao gm: San Diego County, CA. Qu v phi sng trong khu vc ny mi c gia nhp chng trnh ny.



?

6


Gii p

Qu v c phi tr tin hng thng (cn gi l l ph bo him) khi gia nhp chng trnh ca Health Net Cal MediConnect khng?

Qu v s khng phi tr l ph bo him hng thng cho Health Net Cal MediConnect c hng bo him sc khe.

S chp thun trc l g? S chp thun trc l trng hp m qu v phi yu cu Health Net Cal MediConnect chp thun cho qu v trc khi qu v c th nhn mt dch v hay mt loi thuc c th, hoc khi qu v n thm khm nhng nh cung cp dch v khng thuc h thng. Health Net Cal MediConnect c th khng i th cho dch v hay thuc nu qu v khng xin chng trnh chp thun cho qu v. Nu qu v cn c chm sc cp cu hay khn cp, hoc qu v cn c cp dch v thm tch ngoi khu vc, qu v khng cn xin chng trnh chp thun cho qu v trc. Health Net Cal MediConnect c th cung cp cho qu v danh sch cc dch v hoc th thut m yu cu qu v phi xin c s chp thun trc ca Health Net Cal MediConnect trc khi nhn dch v.

S gii thiu l g? S gii thiu l trng hp nh cung cp dch v chm sc chnh ca qu v phi chp thun cho qu v c n thm khm mt ngi no khng phi l nh cung cp dch v chm sc chnh ca qu v. Nu qu v khng c nh cung cp dch v chm sc chnh chp thun, Health Net Cal MediConnect c th khng i th cho nhng dch v ny. C mt s bc s chuyn khoa m qu v khng cn s gii thiu, chng hn nh cc bc s chuyn khoa v sc khe ph n. bit thm thng tin v khi no qu v cn s gii thiu, vui lng xem S tay hi vin.

Tr gip ph tri l g? Tr gip ph tri l mt chng trnh ca Medicare gip gim chi ph trong chng trnh thuc theo toa, nh tin ng tr. Qua Health Net Cal MediConnect, tin ng tr cho thuc theo toa ca qu v tnh c s tin Tr gip ph tri m qu v iu kin c hng. bit thm thng tin v Tr gip ph tri, vui lng lin lc vi Vn phng S An sinh X hi ti a phng ca qu v, hoc gi cho S An sinh X hi theo s 1-800-772-1213. Ngi dng TTY xin gi s 1-800-325-0778.

7



?


Gii p

Qu v cn lin lc vi ai khi c iu g thc mc hoc cn c gip ?

Nu qu v c thc mc chung chung, hoc cn hi v chng trnh, v cc dch v, khu vc dch v, cch lp ha n ca chng ti hoc th ID hi vin, vui lng gi Ban Phc v Hi vin ca Health Net Cal MediConnect. Gi s: 1-855-464-3572

Cc cuc gi ti s ny u min ph. Mt nhn vin trc tip lun sn sng trao i vi qu v t 8 gi sng n 8 gi ti, th Hai n th Su. Sau gi lm vic, vo cui tun v cc ngy l, qu v c th li tin nhn. Chng ti s gi li cho qu v vo ngy lm vic tip theo.

Ban Phc v Hi vin cng c dch v thng dch min ph cho nhng ngi khng ni c ting Anh.

TTY: 711 S ny dnh cho nhng ngi khim thnh hoc khim ngn. Qu v phi c thit b in thoi c bit mi gi c s ny.

Cc cuc gi ti s ny u min ph. Mt nhn vin trc tip lun sn sng trao i vi qu v t 8 gi sng n 8 gi ti, th Hai n th Su. Sau gi lm vic, vo cui tun v cc ngy l, qu v c th li tin nhn. Chng ti s gi li cho qu v vo ngy lm vic tip theo.

Nu qu v c iu g thc mc v tnh trng sc khe ca qu v, vui lng gi ng dy y t c vn.Gi s: 1-855-464-3572

Cc cuc gi ti s ny u min ph. Dch v y t c vn v hun luyn t cc bc s lm sng c o to sn sng phc v 24 gi mt ngy, 7 ngy mt tun.

TTY: 711 S ny dnh cho nhng ngi khim thnh hoc khim ngn. Qu v phi c thit b in

thoi c bit mi gi c s ny. Cc cuc gi ti s ny u min ph. Dch v y t c vn v hun luyn t cc bc s

lm sng c o to sn sng phc v 24 gi mt ngy, 7 ngy mt tun.



?

8


Gii p

Qu v cn lin lc vi ai khi c iu g thc mc hoc cn c gip ? (tip theo)

Nu qu v cn cc dch v sc khe hnh vi ngay lp tc, vui lng gi ng dy h tr khng hong v sc khe hnh vi. Gi s: 1-855-464-3572

Cc cuc gi ti s ny u min ph. Cc bc s lm sng v sc kho hnh vi c cp php sn sng phc v 24 gi mt ngy, 7 ngy mt tun.

TTY: 711 S ny dnh cho nhng ngi khim thnh hoc khim ngn. Qu v phi c thit b in thoi c bit mi gi c s ny.

Cc cuc gi ti s ny u min ph. Cc bc s lm sng v sc kho hnh vi c cp php sn sng phc v 24 gi mt ngy, 7 ngy mt tun.

9



?

Bng sau y trnh by tng qut nhng dch v qu v c th cn, s tin qu v phi tr v nhng quy nh v quyn li c hng.Nhu cu hoc vn v sc khe

Dch v qu v c th cn Chi ph qu v tr cho cc nh cung cp dch v thuc h thng

Gii hn, cc trng hp ngoi l v thng tin v quyn li (quy nh v quyn li)

Qu v mun c thm khm bc s

Khm tr bnh hoc thng tch

$0 Nu qu v cn c chm sc cp cu hay khn cp, hoc qu v cn c cp dch v thm tch ngoi khu vc, qu v khng cn xin chng trnh chp thun cho qu v trc. i vi nhng bui khm thng k, quy nh v s gii thiu v s chp thun trc c th p dng.Qu v phi n bc s, bc s chuyn khoa v bnh vin trong h thng.

Khm khe mnh, nh khm sc khe tng qut

$0 Mt bui khm khe mnh hng nm 12 thng mt ln.

Dch v chuyn ch n vn phng bc s

$0 Dch v chuyn ch phi y t (Non-Medical Transportation, NMT) Ti a 30 chuyn i mt chiu n cc a im c chng trnh chp thun bng xe t ch khch, taxi hoc cc hnh thc chuyn ch t/cng cng khc hng nm. C th p dng cc yu cu v s gii thiu.Dch v chuyn ch y khoa khng cp cu (Non-Emergency Medical Transportation NEMT) L cc dch v cn phi c nhn cc dch v y t c i th, v tnh trng y t ca qu v khng cho php qu v di chuyn bng xe but, xe t ch khch, xe taxi hoc hnh thc chuyn ch t/cng cng khc. C th p dng cc quy nh v s gii thiu v s chp thun trc.

Chm sc chuyn khoa $0 Qu v phi n bc s, bc s chuyn khoa v bnh vin trong h thng. C th p dng cc quy nh v s chp thun trc. Qu v cn c gii thiu n cc bc s chuyn khoa trong h thng ( hng mt s quyn li c th).



?

10

Nhu cu hoc vn v sc khe



Qu v mun c thm khm bc s (tip theo)

Chm sc trnh b bnh, nh chch nga cm

$0 Khng cn s gii thiu hoc s chp thun trc khi chch nga vc-xin cm hay chch nga vc-xin vim phi. Quy nh v s gii thiu v s chp thun trc c th p dng cho nhng dch v khc.

Khm phng nga trong t Cho mng hi vin tham gia Medicare (ch mt ln)

$0 Trong 12 thng u khi qu v bt u nhn quyn li bo him Phn B mi, qu v c th c Khm phng nga trong t cho mng hi vin tham gia Medicare hoc c Khm khe mnh hng nm. Qua 12 thng u, qu v c th c Khm khe mnh hng nm 12 thng mt ln.

Qu v cn xt nghim y khoa

Xt nghim trong phng th nghim, nh xt nghim mu

$0 C th p dng cc quy nh v s gii thiu v s chp thun trc.

Chp quang tuyn X hoc nhng loi chp nh khc, nh chp nh CAT


Xt nghim sng lc, nh xt nghim d tm ung th

$0 Ty thuc vo dch v, c th p dng cc quy nh v s gii thiu v s chp thun trc.

11



?




Qu v cn thuc cha bnh hay bnh trng

Thuc gc (khng phi bit dc)

$0 n $3.35 tin ng tr cho lng thuc dng trong 30 ngy. Tin ng tr cho thuc theo toa c th thay i ty theo mc Tr gip ph tri qu v nhn c. Vui lng lin lc vi chng trnh bit thm chi tit.

C th c nhng gii hn p dng i vi nhng loi thuc c i th. Vui lng xem Danh sch thuc c i th (Danh sch thuc) ca Health Net Cal MediConnect bit thm thng tin. Qu v c th nhn thuc ti cc nh thuc bn l trong h thng v nh thuc c dch v t mua thuc qua bu in.Nu qu v sng trong mt c s chm sc di hn, qu v s tr s tin tng t nh ti nh thuc bn l.Ch trong mt vi trng hp, chng ti s i th thuc theo toa c mua ti cc nh thuc khng thuc h thng. Nu qu v tm n nh thuc khng thuc h thng, qu v s phi tr ton b chi ph cho s thuc theo toa ca qu v. Qu v phi gi cho chng ti bn sao giy bin nhn v sau yu cu chng ti hon tr qu v phn chia s chi ph ca chng ti. Vui lng tham kho Chng 5 trong S tay hi vin tm hiu thm v cc nh thuc khng thuc h thng.i vi mt s loi thuc, qu v c th nhn lng thuc di hn (cn c gi l "lng thuc lu di") khi qu v mua thuc theo toa. Lng thuc di hn dng trong ti a 90 ngy. Qu v phi tr s tin tng ng vi lng thuc dng trong mt thng.Giai on i th tai ng Sau khi chi ph mua thuc qu v phi t tr hng nm ln n $5,000, qu v s tr $0 cho cc loi thuc trong danh mc thuc ca chng trnh.



?

12




Qu v cn thuc cha bnh hay bnh trng(tip theo)

Bit dc $0 n $8.35 tin ng tr cho lng thuc dng trong 30 ngy. Tin ng tr cho thuc theo toa c th thay i ty theo mc Tr gip ph tri qu v nhn c. Vui lng lin lc vi chng trnh bit thm chi tit.

C th c nhng gii hn p dng i vi nhng loi thuc c i th. Vui lng xem Danh sch thuc c i th (Danh sch thuc) ca Health Net Cal MediConnect bit thm thng tin. Qu v c th nhn thuc ti cc nh thuc bn l trong h thng v nh thuc c dch v t mua thuc qua bu in.Nu qu v sng trong mt c s chm sc di hn, qu v s tr s tin tng t nh ti nh thuc bn l.Ch trong mt vi trng hp, chng ti s i th thuc theo toa c mua ti cc nh thuc khng thuc h thng. Nu qu v tm n nh thuc khng thuc h thng, qu v s phi tr ton b chi ph cho s thuc theo toa ca qu v. Qu v phi gi cho chng ti bn sao giy bin nhn v sau yu cu chng ti hon tr qu v phn chia s chi ph ca chng ti. Vui lng tham kho Chng 5 trong S tay hi vin tm hiu thm v cc nh thuc khng thuc h thng.i vi mt s loi thuc, qu v c th nhn lng thuc di hn (cn c gi l "lng thuc lu di") khi qu v mua thuc theo toa. Lng thuc di hn dng trong ti a 90 ngy. Qu v phi tr s tin tng ng vi lng thuc dng trong mt thng.Giai on i th tai ng Sau khi chi ph mua thuc qu v phi t tr hng nm ln n $5,000, qu v s tr $0 cho cc loi thuc trong Danh sch thuc ca chng trnh.

13



?




Qu v cn thuc cha bnh hay bnh trng(tip theo)

Thuc mua t do khng cn toa

$0 C th c nhng gii hn p dng i vi nhng loi thuc c i th. Vui lng xem Danh sch thuc c i th (Danh sch thuc) ca Health Net Cal MediConnect bit thm thng tin.

Thuc theo toa trong chng trnh Medicare Phn B

$0 Thuc Phn B gm nhng loi thuc bc s cp cho ti vn phng, mt s loi thuc tr ung th dng ung v mt s loi thuc dng vi mt s dng c y khoa. Vui lng xem S tay hi vin bit thm thng tin v nhng loi thuc ny. C th p dng cc quy nh v s chp thun trc.

Qu v cn tr liu sau khi b t qu hoc tai nn

Tr liu chc nng hot ng, vt l tr liu hoc m ng tr liu

$0 Cc dch v v vt l tr liu, tr liu chc nng hot ng cng nh tr liu bnh l m ng v ngn ng c tnh cch cn thit v mt y t s c i th.C th p dng cc quy nh v s gii thiu v s chp thun trc.

Qu v cn c chm sc cp cu

Dch v ti phng cp cu $0 Qu v c cung cp dch v chm sc y t cp cu c i th bt c lc no qu v cn, bt c ni no ti Hoa K hoc ti cc vng lnh th ca Hoa K.Khng cn s chp thun trc.Khng c i th ngoi Hoa K v cc lnh th ca Hoa K, ngoi tr mt s trng hp gii hn. Vui lng lin lc vi chng trnh bit thm chi tit.



?

14




Qu v cn c chm sc cp cu (tip theo)

Dch v xe cu thng $0 Khng yu cu s chp thun trc i vi cc dch v xe cu thng cp cu trong h thng v ngoi h thng.i vi cc dch v xe cu thng khng cp cu, c th p dng cc quy nh v s chp thun trc.

Chm sc khn cp $0 Qu v c th nhn cc dch v chm sc khn cp c i th bt c lc no qu v cn, bt c ni no ti Hoa K hoc ti cc vng lnh th ca Hoa K. Khng cn s chp thun trc.

Qu v cn c chm sc ti bnh vin

Nm vin $0 Khng gii hn s ngy nm vin c tnh cch cn thit v mt y t c chng trnh i th mi ln nm vin.Ngoi tr trng hp cp cu, bc s ca qu v phi cho chng trnh bit khi qu v sp sa nhp vin.Qu v phi n bc s, bc s chuyn khoa v bnh vin trong h thng.C th p dng cc quy nh v s gii thiu v s chp thun trc cho cc trng hp nm vin khng cp cu.

Dch v chm sc do bc s hoc bc s gii phu cung cp

$0 Dch v chm sc t bc s hoc bc s gii phu c cung cp chung vi quyn li nm vin.

15



?




Qu v cn c gip hi phc hoc qu v c nhu cu c bit v sc khe

Dch v phc hi chc nng $0 Dch v phc hi chc nng ngoi chn Cc dch v v vt l tr liu, tr liu chc nng hot ng cng nh tr liu bnh l m ng v ngn ng c tnh cch cn thit v mt y t s c i th.C th p dng cc quy nh v s gii thiu v s chp thun trc.Cc dch v phc hi chc nng tim v phi C th p dng cc quy nh v s gii thiu v s chp thun trc.

Dng c y khoa chm sc ti nh


Chm sc iu dng chuyn mn

$0 C s iu dng chuyn mn (Skilled Nursing Facility, SNF) Khng gii hn s ngy c chng trnh i th mi ln vo SNF.Khng bt buc phi nm vin trc . C th p dng cc quy nh v s gii thiu v s chp thun trc.Chm sc sc khe ti gia Gm chm sc iu dng chuyn mn khng lin tc v c tnh cch cn thit v mt y t, cc dch v h tr chm sc sc khe ti gia v cc dch v phc hi chc nng.C th p dng cc quy nh v s chp thun trc.



?

16




Qu v cn c chm sc mt

Khm mt $0 Khm mt c tnh cch cn thit v mt y t chn on v iu tr cc chng bnh v tnh trng ca mt, gm c khm sng lc bnh tng nhn p hng nm cho nhng ngi c nguy c mc bnh. C th p dng cc quy nh v s gii thiu.Ti a 1 ln khm mt thng k b sung mi nm.

Knh eo mt hoc knh p trng

$0 Mt cp knh eo mt (trng v gng) hoc knh p trng sau khi gii phu c thy tinh th. Gii hn quyn li bo him ca chng trnh l $100 i vi knh thuc b sung bao gm knh eo mt (mt knh v gng knh) hoc knh p trng hai nm mt ln.

Qu v cn dch v thnh gic

Khm sng lc thnh gic $0 C th p dng cc quy nh v s gii thiu v s chp thun trc.

Dng c tr thnh $0 Gii hn i vi cc dch v c Medi-Cal i th. Quyn li i vi dng c tr thnh c gii hn n $1,510 mi nm ti chnh. Gii hn khng p dng cho nhng ngi hng sng ti c s iu dng hoc ph n mang thai. C th p dng cc quy nh v s gii thiu.

Qu v c bnh mn tnh nh bnh tiu ng hoc bnh tim

Dch v gip qu v kim sot chng bnh


17



?




Qu v c bnh mn tnh nh bnh tiu ng hoc bnh tim(tip theo)

Dch v v vt liu dng cho bnh tiu ng

$0 Hun luyn t kim sot bnh tiu ng.Vt liu dng theo di bnh tiu ng.Cc loi giy iu chnh bn chn v vt dng nng lng bn chn.Dch v v vt liu dng cho bnh tiu ng c cung cp gii hn theo nh sn xut, sn phm v/hoc thng hiu c th. C th p dng cc quy nh v s gii thiu v s chp thun trc.

Qu v c bnh v sc khe tm thn

Dch v sc khe tm thn hoc sc khe hnh vi

$0 Khm tr liu c nhn.Khm tr liu theo nhm.Khm tr liu c nhn vi bc s tm thn.Khm tr liu theo nhm vi bc s tm thn.Dch v thuc chng trnh nhp vin bn phn.C th p dng cc quy nh v s chp thun trc.




?

18




Qu v c vn v lm dng cht gy nghin

Dch v chm sc tnh trng lm dng cht gy nghin

$0 Chm sc bnh vin ni tr Bao gm Dch v phc hi chc nng v chm sc tnh trng lm dng cht gy nghin.Khng gii hn s ngy do chng trnh i th mi ln nm vin.Ngoi tr trng hp cp cu, bc s ca qu v phi cho chng trnh bit khi qu v sp sa nhp vin.C th p dng cc quy nh v s gii thiu v s chp thun trc.Chm sc tnh trng lm dng cht gy nghin ngoi chn Khm iu tr tnh trng lm dng cht gy nghin ngoi chn cho c nhn.Khm iu tr tnh trng lm dng cht gy nghin ngoi chn theo nhm.C th p dng cc quy nh v s chp thun trc.

19



?




Qu v cn dch v sc khe tm thn di hn

Chm sc ni tr cho nhng ngi cn c chm sc sc khe tm thn

$0 Qu v c chm sc ni tr ti bnh vin tm thn ti a 190 ngy trong c i. Nhng dch v chm sc ni tr ti bnh vin tm thn tnh vo 190 ngy gii hn ti a sut i ch p dng khi p ng c mt s iu kin. S gii hn ny khng p dng cho nhng dch v chm sc tm thn ni tr c cung cp ti bnh vin a khoa.Chng trnh i th 60 ngy d tr sut i.Ngoi tr trng hp cp cu, bc s ca qu v phi cho chng trnh bit khi qu v sp sa nhp vin.C th p dng cc quy nh v s chp thun trc.C s cung cp dch v chm sc bnh tm thn cho nhng ngi 65 tui tr lnC th p dng cc quy nh v s gii thiu v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.

Qu v cn dng c y khoa lu bn (durable medical equipment, DME)

Xe ln $0C th p dng cc quy nh v s gii thiu v s chp thun trc.(Lu : y khng phi l danh sch y tt c cc vt liu hoc DME c i th. Vui lng lin lc vi chng trnh bit thm chi tit.)

My xng kh dung $0Nng $0Khung tp i $0Thit b v cc ngun tip liu xy

$0



?

20




Qu v cn c gip sng ti nh

Thc n mang n nh $0 C th p dng cc quy nh v s chp thun trc. Vui lng lin lc vi chng trnh bit thm chi tit.Dch v ny ch c cung cp cho cc hi vin tiu chun c min tr trong Chng trnh dch v a dng cho ngi cao nin (MSSP). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang. MSSP c i th ti a $4,285 mt nm.

Dch v tr gip ti nh, nh v sinh hoc trng coi nh ca

$0 C th p dng cc quy nh v s chp thun trc. Vui lng lin lc vi chng trnh bit thm chi tit.Dnh cho hi vin hi tiu chun c min tr trong Chng trnh dch v a dng cho ngi cao nin (MSSP). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang. MSSP c i th ti a $4,285 mt nm.

Sa cha nh , nh xy dc i v li i cho xe ln

$0 C th p dng cc quy nh v s chp thun trc. Vui lng lin lc vi chng trnh bit thm chi tit.Dnh cho hi vin hi tiu chun c min tr trong Chng trnh dch v a dng cho ngi cao nin (MSSP). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang. MSSP c i th ti a $4,285 mt nm.

21



?




Qu v cn c gip sng ti nh(tip theo)

Dch v chm sc sc khe ti gia

$0 C th p dng cc quy nh v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.

Dch v gip cho qu v sng t lp

$0 C th p dng cc quy nh v s chp thun trc. Vui lng lin lc vi chng trnh bit thm chi tit.Dnh cho cc hi vin tiu chun c min tr Dch v phc v ngi ln qua t chc cng ng (CBAS) v Chng trnh dch v a dng cho ngi cao nin (MSSP). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang. MSSP c i th ti a $4,285 mt nm.

Dch v ban ngy dnh cho ngi ln hoc nhng dch v h tr khc

$0 C th p dng cc quy nh v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.Dnh cho hi vin tiu chun nhn Dch v phc v ngi ln qua t chc cng ng (vit tt trong ting Anh l CBAS). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang.



?

22




Qu v cn ni sng vi nhng ngi sn sng gip qu v

C tr ti ni c tr gip hoc nhng dch v v nh khc

$0 C th p dng cc quy nh v s chp thun trc.C th p dng cc yu cu v s gii thiu. Vui lng lin lc vi chng trnh bit thm chi tit.Chng trnh s tr gip iu phi cc dch v c cung cp qua cc t chc nh Trung tm C tr T lp hoc nhng chng trnh nh Chng trnh min tr c tr c tr gip. Vui lng lin lc vi chng trnh bit thm chi tit.

Chm sc ti vin iu dng $0 C th p dng cc quy nh v s gii thiu v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.

Ngi chm sc cho qu v cn thi gian ngh ngi

Chm sc tm th $0 C th p dng cc quy nh v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.Dnh cho hi vin hi tiu chun c min tr trong Chng trnh dch v a dng cho ngi cao nin (MSSP). C th p dng cc yu cu v tnh hi tiu chun ca tiu bang. MSSP c i th ti a $4,285 mt nm.

23



?

Nhng dch v khc c Health Net Cal MediConnect i thy khng phi l mt danh sch y . Vui lng gi Ban Phc v Hi vin hoc xem S tay hi vin tm hiu thm v cc dch v c i th khc.

Cc dch v khc c i tho bi Health Net Cal MediConnect

Chi ph qu v tr cho cc nh cung cp dch v thuc h thng

Dch v chnh nn xng $0Khm chnh nn xng dnh cho nhng dch v nn chnh ct sng bng tay cha sai khp (tnh trng lch hoc trt mt khp hoc b phn c th). C th p dng cc quy nh v s gii thiu v s chp thun trc.

Dch v chm cu $0Chng ti s tr cho ti a hai dch v chm cu ngoi chn trong bt k mt thng tnh theo lch no, hoc thng xuyn hn nu nhng dch v c tnh cch cn thit v mt y t.

Dch v chm sc bn chn $0Khm bn chn dnh cho nhng dch v chm sc bn chn c tnh cch cn thit v mt y t.

Dng c c th gi $0Vt liu y khoa lin quan n cc b phn c th gi, np v nhng thit b khc.C th p dng cc quy nh v s chp thun trc.

Kem thoa v t cho tnh trng tiu tin v i tin khng t ch

$0C th p dng cc quy nh v s gii thiu v s chp thun trc.



?

24



Bnh thn v nhng bnh trng v thn $0 Thm tch ni tr, ngoi chn v ti gia. Chng trnh i th cho cc dch

v thm tch thn khi qu v ra khi khu vc dch v ca chng trnh trong mt thi gian ngn. Qu v c th nhn dch v thm tch ti cc c s thm tch c Medicare chng nhn.

Dch v gio dc v bnh thn.C th p dng cc quy nh v s gii thiu v s chp thun trc.

Chng trnh gio dc/chm sc khe mnh v cc quyn li b tc khc

$0Chng trnh i th cho nhng chng trnh gio dc/chm sc khe mnh b tc sau y: Gio dc v sc khe Quyn li v dinh dng/ch n Cc bui hc b sung t vn b ht thuc l v cai thuc lC th p dng cc quy nh v s chp thun trc i vi Gio dc v sc khe, Quyn li v dinh dng/ch n v Cc bui hc b sung t vn b ht thuc l v cai thuc l. ng dy nng ph trch v iu dng

T vn v b ht thuc l cho ph n mang thai

$0C th p dng cc quy nh v s gii thiu v s chp thun trc.

Qun l h s $0Vui lng lin lc vi chng trnh bit thm chi tit.

Cc dch v k hoch ha gia nh $0Vui lng lin lc vi chng trnh bit thm chi tit.


25



?



Dch v dnh cho ngi sng ti c s iu dng

$0Ngi sng ti c s iu dng: Chm sc bng phng php chnh nn xng v chm sc bn chn Nhn khoa v nha khoa Chm cu Khm thnh gic v dng c tr thnhC th p dng cc quy nh v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.

Chng trnh dch v a dng cho ngi cao nin (MSSP)

$0C th p dng cc quy nh v s chp thun trc.Vui lng lin lc vi chng trnh bit thm chi tit.Gii hn quyn li bo him ca chng trnh cho Chng trnh dch v a dng cho ngi cao nin (MSSP) l $4,285 mi nm. C th p dng cc yu cu v tnh hi tiu chun ca tiu bang.




?

26

Cc dch v khc c Medicare hoc Medi-Cal i tho

Chi ph cua qu v

Mt s dch v chm sc giai on cui i $0Cc dch v iu phi trc khi chuyn tip v cc dch v sau khi chuyn tip trong Dch v chuyn tip trong cng ng California (California Community Transitions, CCT)

$0

Mt s dch v nha khoa, bao gm v sinh, trm rng v lp ton hm rng gi

Qu v khng mt ph i vi cc dch v c i th theo Chng trnh nha khoa ca Medi-Cal. Tuy nhin, qu v phi chu phn chia s chi ph ca qu v, nu c. Qu v chu trch nhim chi tr cc dch v khng c chng trnh ca qu v hoc Medi-Cal i th.

Cc quyn li c i th bn ngoi Health Net Cal MediConnecty khng phi l mt danh sch y . Hy gi Ban Phc v Hi vin tm hiu v cc dch v khc khng c Health Net Cal MediConnect i th nhng li c sn thng qua Medicare hoc Medi-Cal.

27



?

Cc dch v m Health Net Cal MediConnect, Medicare v Medi-Cal khng i th y khng phi l mt danh sch y . Vui lng gi Ban Phc v Hi vin tm hiu thm v cc dch v b loi tr khc.Cc dch v khng c i tho bi Health Net Cal MediConnect, Medicare hoc Medi-CalNhng dch v khng "hp l v cn thit" th theo tiu chun ca Medicare v Medi-Cal, tr khi nhng dch v ny c chng trnh chng ti lit k l dch v c i th.Nhng phng php tr liu y khoa v gii phu, vt liu v thuc c tinh cht thi nghim, tr khi c Medicare i th hoc thuc mt cng trnh nghin cu lm sng c Medicare chp thun hay c chng trnh ca chng ti i th. Nhng phng php tr liu v vt dng c tinh cht thi nghim l nhng th ni chung khng c cng ng y khoa chp nhn.Nhng th thut hoc dch v t chn hoc t nguyn gip ci thin tnh trang c nhn (gm c gim cn, mc tc, kh nng tnh dc, kh nng th thao, thm m, chng lo ha v kh nng tri tu), tr khi c tinh cch cn thit v mt y t.Gii phu thm m hoc nhng th thut thm m khc, tr khi cn thit v b chn thng do tai nan hoc chnh sa nhng phn ca c th c hnh dang khng bnh thng. Tuy nhin, chng trnh s chi tr cho th thut ti tao mt bn v sau khi tin hnh th tc ct b v v chi tr cho vic iu tr bn v cn lai cho ngc c cn xng.Th thut khi phc kh nng sinh sn v cc vt dng nga thai khng cn toa.



?

28

Quyn cua qu v vi t cch l hi vin cua chng trnh Vi t cch l hi vin ca chng trnh Health Net Cal MediConnect, qu v c mt s quyn. Quy v c th thc thi nhng quyn ny m khng b trng phat. Quy v cng c th dng nhng quyn ny m khng b mt i cc dch v chm sc sc khe ca mnh. Chng ti s cho qu v bit v quyn ca qu v it nht mt ln mi nm. bit thng tin chi tit v quyn ca qu v, vui lng xem S tay hi vin. Quyn ca qu v bao gm, nhng khng gii han bi nhng quyn sau y:

Qu v c quyn c tn trong, i x cng bng v tn trong nhn phm. Quyn ny gm c: Quyn c nhn cc dch v c i th m khng phi quan

tm n chng tc, dn tc, ngun gc quc gia, tn gio, gii tinh, tui tc, tnh trang khuyt tt v tm thn hay th cht, khuynh hng tnh dc, thng tin di truyn, kh nng thanh ton chi phi hoc kh nng ni ting Anh.

Quyn c nhn thng tin di cc nh dang khc (nh bn in kh ln, ch ni braille v/hoc m thanh).

Quyn khng b kim ch hay c lp v mt th cht di bt c hnh thc no.

Quyn khng b cc nh cung cp dch v thuc h thng tinh ha n.

Quyn c gii p thc mc v nhng iu qu v quan tm mt cch y v lch s.

Qu v c quyn c bit thng tin v dch v chm sc sc khe cua qu v. Nhng thng tin ny gm thng tin v bin php iu tr v nhng phng n iu tr qu v c th chn. Nhng thng tin ny phi c trnh by bng hnh thc d hiu cho qu v. Nhng quyn ny gm quyn c nhn thng tin v: Cc dch v m chng ti i th. Cch thc nhn dch v.

Chi phi qu v phi tr cho cc dch v. Tn ca cc nh cung cp dch v chm sc sc khe v qun l

chm sc.

Qu v c quyn quyt nh v s chm sc sc khe cua mnh, k c quyn t chi iu tr. Quyn ny gm c: Quyn chn Nh cung cp dch v chm sc chinh (Primary

Care Provider, PCP) v c th i PCP bt c lc no. Quyn n thm khm nh cung cp dch v chm sc sc khe

ph n m khng cn s gii thiu. Quyn c nhn cc dch v v thuc c i th mt cch

nhanh chng. Quyn c bit v tt c cc phng n iu tr qu v khng

k chi phi ca nhng phng php ny ra sao hay c c i th hay khng.

Quyn t chi iu tr, d bc s ca qu v khuyn qu v khng nn quyt nh nh th.

Quyn dng dng thuc. Quyn yu cu kin y khoa th nh. Health Net

Cal MediConnect s chi tr chi phi qu v i khm ly kin y khoa th nh.

Quyn lp v p dng tin ch th v chm sc sc khe, nh nguyn tr liu hoc giy y quyn v chm sc sc khe.

29



?

Qu v c quyn c chm sc sc khe ng lc m khng b cn tr v tip cn vt l hay giao tip. Quyn ny gm c: Quyn c chm sc y t ng lc. Quyn c n v ri vn phng ca nh cung cp dch v

chm sc sc khe. iu ny c ngha l vn phng ca nh cung cp dch v chm sc sc khe phi tin nghi v d dng cho ngi khuyt tt, th theo ao lut ngi M khuyt tt.

c thng dch vin gip qu v c th giao tip vi bc s v chng trnh bo him sc khe. Hy gi 1-855-464-3572 (TTY: 711), Th Hai n ht th Su, 8:00 sng n 8:00 ti nu qu v cn gip v dch v ny.

Qu v c quyn tm cch c chm sc cp cu v khn cp khi cn. iu ny ng ngha vi vic qu v c quyn: c cung cp dch v cp cu, 24 gi mt ngy, by ngy mt

tun, khng cn s chp thun trc trong trng hp cp cu.- c thm khm cc nh cung cp dch v chm sc cp cu

hoc khn cp ngoi h thng khi cn.

Qu v c quyn c gi kn thng tin ring t. Quyn ny gm c: Quyn yu cu v nhn bn sao h s y khoa ca qu v bng

mt hnh thc m qu v c th hiu c v quyn yu cu thay i hoc sa i h s ca mnh.

Quyn c gi kin thng tin sc khe c nhn.

Qu v c quyn np n than phin v cc dch v hoc dch v chm sc c i tho. Quyn ny gm c: Quyn np n than phin hoc khiu nai i vi chng ti

hoc i vi cc nh cung cp dch v chm sc sc khe ca chng ti. Quy v cng c quyn khng co mt s quyt nh do chng ti hoc cc nh cung cp dch v chm sc sc khe ca chng ti a ra.

Yu cu Duyt xet y khoa c lp cc dch v hoc vt dng ca Medi-Cal v bn cht l dng trong y t t B Qun tr Chm sc Sc khe California.

Quyn yu cu Tiu bang California m phin iu trn cng bng cp tiu bang.

Quyn c bit r rng l do tai sao dch v b t chi.

bit thm thng tin v quyn ca qu v, vui lng xem S tay hi vin ca Health Net Cal MediConnect. Nu qu v c iu g thc mc, qu v cng c th gi Ban Phc v Hi vin ca HealthNet Cal MediConnect.



?

30

Nu qu v c iu g mun than phin hoc ngh l chng ti phi i tho mt dch v no nhng chng ti t chiNu quy v c iu g mun than phin hoc ngh l chng trnh Health Net Cal MediConnect phi i th mt dch v no nhng chng ti t chi, xin quy v gi Health Net Cal MediConnect theo s 1-855-464-3572 (TTY: 711) t 8 gi sng n 8 gi ti, th hai n th ht th Su. Sau gi lm vic, vo cui tun v cc ngy l, quy v c th lai tin nhn. Chng ti s gi lai cho quy v vo ngy lm vic tip theo. Cuc gi ny min phi. Quy v c th khng co quyt nh ca chng ti.

gii p thc mc v cc than phin v khng co ca qu v, vui lng xem Chng 9 trong S tay hi vin ca Health Net Cal MediConnect. Ngoi ra, qu v cng c th gi Ban Phc v Hi vin ca Health Net Cal MediConnect.

Nu qu v gp mt vn g, c iu g quan ngai hoc thc mc lin quan n quyn li hoc dch v chm sc ca qu v, xin qu v gi Ban Phc v Hi vin ca Health Net Cal MediConnect theo s 1-855-464-3572 (TTY: 711), th Hai n ht th Su t 8:00 sng n 8:00ti. Sau gi lm vic, vo cui tun v cc ngy l, qu v c th li tin nhn. Chng ti s gi li cho qu v vo ngy lm vic tip theo. Cuc gi ny min phi.

Nu qu v nghi ng c s gian lnHu ht chuyn vin chm sc sc khe v cc t chc cung cp dch v u lng thin. Nhng tic thay cng c mt s thnh phn khng lng thin.

Nu qu v ngh l bc s, bnh vin hay nh thuc no lm iu g sai tri, xin qu v lin lac vi chng ti.

Gi cho chng ti qua Ban Phc v Hi vin ca Health Net Cal MediConnect. S in thoai c ghi trn trang ba ca tp tm lc quyn li ny.

Hoc gi cho Medicare theo s 1-800-MEDICARE (1-800-633-4227). Ngi dng TTY xin gi s 1-877-486-2048. Quy v c th gi n cc s in thoai ny 24 gi mt ngy, 7 ngy mt tun.

ng dy nng t co tnh trang gian ln v lam dng ca B Y t California theo s 1-800-822-6222, hoc Vn phng chng Gian ln v Lam dng Ngi cao tui trong Medi-Cal thuc Vn phng B trng B T php theo s 1-800-722-0432. Cuc gi ca qu v c min phi v bo mt.

31



?

Thng bo v khng k thHealth Net Cal MediConnect Plan (Medicare-Medicaid Plan) tun th cc lut dn quyn hin hnh ca lin bang v khng k th da trn chng tc, mu da, ngun gc quc gia, tui tc, tnh trang khuyt tt hay gii tinh. Health Net Cal MediConnect khng loai tr hoc i x phn bit v ly do chng tc, mu da, ngun gc quc gia, tui tc, tnh trang khuyt tt, hay gii tinh.

Health Net Cal MediConnect: Cung cp cc tr gip v dch v min phi cho ngi khuyt tt h giao tip hiu qu vi chng ti,

vi d nh thng dch vin ngn ng k hiu c trnh v thng tin bng vn bn cc nh dang khc (bn in kh ln, nh dang in t c th truy cp, cc nh dang khc).

Cung cp cc dch v ngn ng min phi cho ngi c ngn ng chinh khng phi ting Anh, vi d nh cc thng dch vin c trnh v thng tin di dang vn bn bng cc ngn ng khc.

Nu quy v cn cc dch v ny, hy lin h vi Trung tm Lin lac Hi vin ca Health Net Cal MediConnect theo s 1-855-464-3572 (TTY: 711) t 8 gi sng n 8 gi ti, th Hai n th ht th Su. Sau gi lm vic, vo cui tun v cc ngy l, quy v c th lai tin nhn. Chng ti s gi lai cho quy v vo ngy lm vic tip theo. Cuc gi ny min phi.Nu quy v cho rng Health Net Cal MediConnect khng cung cp nhng dch v ny hoc k th theo cch khc da trn chng tc, mu da, ngun gc quc gia, tui tc, tnh trang khuyt tt, hay gii tinh, quy v c th np n khiu nai bng cch gi n s in thoai nu trn v cho h bit quy v cn gip np n khiu nai; Trung tm Lin lac Hi vin ca Health Net Cal MediConnect sn sng gip quy v.

Quy v cng c th np than phin v dn quyn ln Vn phng Dn Quyn thuc B Y t v Dch v Nhn sinh Hoa K, bng phng thc in t thng qua Cng Than phin ca Vn phng Dn Quyn, c trn trang https://ocrportal.hhs.gov/ocr/portal/lobby.jsf hoc gi th qua ng bu in hay gi in thoai theo a ch: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, (TDD: 1-800-537-7697). Cc mu n than phin c sn tai a ch http://www.hhs.gov/ocr/office/file/index.html.

Health Net Community Solutions, Inc. l cng ty chi nhnh ca Health Net, Inc. Health Net l thng hiu dch v ng k ca Health Net, Inc. Mi quyn c bo lu.

BKT014709VP00 (7/17)

CMC Nondiscrimination Notice_LP FLY015186EO00 (8/17)

CA_MMP_2017_NDN_08242017

Health Net Cal MediConnect Nondiscrimination Notice

Health Net Community Solutions, Inc. (Health Net Cal MediConnect Plan (Medicare-Medicaid Plan))

complies with applicable federal civil rights laws and does not discriminate on the basis of race, color,

national origin, age, disability, or sex. Health Net Cal MediConnect does not exclude people or treat

them differently because of race, color, national origin, age, disability, or sex.

Health Net Cal MediConnect:

Provides free aids and services to people with disabilities to

communicate effectively with us, such as qualified sign language

interpreters and written information in other formats (large print,

accessible electronic formats, other formats).

Provides free language services to people whose primary language

is not English, such as qualified interpreters and information written

in other languages.

If you need these services, contact the Health Net Cal MediConnect

Customer Contact Center at 1-855-464-3571 (Los Angeles),

1-855-464-3572 (San Diego) (TTY: 711) from 8 a.m. to 8 p.m.,

Monday through Friday. After hours, on weekends and on holidays,

you can leave a message. Your call will be returned within the next

business day. The call is free.

If you believe that Health Net Cal MediConnect has failed to provide these services or discriminated in

another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance

by calling the number above and telling them you need help filing a grievance; the Health Net Cal

MediConnect Customer Contact Center is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services,

Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and

Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201,

1-8003681019, (TDD: 1-8005377697). Complaint forms are available at

http://www.hhs.gov/ocr/office/file/index.html.

Multi-Language Insert Multi-language Interpreter Services

English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Spanish: ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Llame al 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Chinese Mandarin: 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711)

Chinese Cantonese: 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego)TTY: 711

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Vietnamese: CH : Nu bn ni Ting Vit, c cc dch v h tr ngn ng min ph dnh cho bn. Gi s 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Korean: : , 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711). .

Russian: : , . 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Arabic: : . .(TTY: 711) (San Diego) 1-855-464-3572 (Los Angeles) 1-855-464-3571

Hindi: : 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711). .

Japanese: 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Farsi: : . .(TTY: 711) 1-855-464-3572 (San Diego), 1-855-464-3571 (Los Angeles)

Thai: : 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

H3237_17_MLI_Accepted_09092017

Armenian: , : 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711)

Cambodian: , 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Punjabi: : , 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711)

Laotian: : , . 1-855-464-3571 (Los Angeles), 1-855-464-3572 (San Diego) (TTY: 711).

Cal MediConnect Member Multi-Language Insert FLY015174ZO00 (8/17)

tóm lược quyền lợi năm 2018 - health net€¦ · nếu quý vị có điều gì thắc...

Documents