Nondiscrimination and language assistance notice

Nondiscrimination notice

Discrimination is against the law. Blue Shield of California Promise Health Plan follows State and Federal civil rights laws. Blue Shield of California Promise Health Plan does not unlawfully discriminate, exclude people, or treat them differently because of sex, race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation.

Download the nondiscrimination notice in other languages:

Blue Shield of California Promise Health Plan provides:

• Free aids and services to people with disabilities to help them communicate better, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, and other formats)

• Free language services to people whose primary language is not English, such as:
  • Qualified interpreters
  • Information written in other languages
     

If you need these services, contact Blue Shield of California Promise Health Plan between 8 a.m. – 6 p.m., Monday through Friday. Call Customer Care in your region:

(800) 605-2556 (Los Angeles)
(855) 699-5557 (San Diego)

If you cannot hear or speak well, please call TTY: 711.

Upon request, this document can be made available to you in braille, large print, audiocassette, or electronic form. To obtain a copy in one of these alternative formats, please call or write to:

(800) 605-2556 (Los Angeles)
(855) 699-5557 (San Diego)
TTY: 711

Blue Shield of California Promise Health Plan Customer Care
601 Potrero Grande Dr.
Monterey Park, CA  91755

How to file a grievance

If you believe that Blue Shield of California Promise Health Plan has failed to provide these services or unlawfully discriminated in another way on the basis of race, color, religion, ancestry, national origin, ethnic group identification, age, mental disability, physical disability, medical condition, genetic information, marital status, gender, gender identity, or sexual orientation, you can file a grievance with Blue Shield of California Promise Health Plan’s Civil Rights Coordinator. You can file a grievance by phone, in writing, in person, or electronically:

• By phone: Contact Blue Shield of California Promise Health Plan’s civil rights coordinator between 8 a.m. – 6 p.m., Monday – Friday by calling (844) 883-2233. 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:
  Blue Shield of California Promise Health Plan Civil Rights Coordinator
  601 Potrero Grande Dr.
  Monterey Park, CA  91755

• In person: Visit your doctor’s office or Blue Shield of California Promise Health Plan and say you want to file a grievance.

• Electronically: Visit Blue Shield of California Promise Health Plan’s website at blueshieldca.com/promise.
   

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 TTY: 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
  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 basis 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, 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.

Free interpreter services and information in other languages

Blue Shield Promise provides free language services to people whose primary language is not English. Contact us for assistance.

You can also call 1-800-605-2556 (TTY: 711) for Los Angeles County, or 1-855-699-5557 (TTY: 711) for San Diego County.
Aids and services for people with disabilities, like documents in braille or large print, are also available. These services are free of charge.

Blue Shield Promise Medi-Cal members
Language assistance notices: English, Arabic, Armenian, Cambodian, Chinese, Farsi, Hindi, Hmong, Japanese, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Vietnamese

Los Angeles County (PDF, 901 KB)
San Diego County (PDF, 499 KB)

Blue Shield Promise Cal MediConnect members
Nondiscrimination and language assistance notice: English, Arabic, Armenian, Cambodian, Chinese, Farsi, Hindi, Hmong, Japanese, Khmer, Korean, Laotian, Mien, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Vietnamese (PDF, 544 KB)