Affordable Care Act

Non-Discrimination and Language Assistance Notice

Discrimination is Against the Law

Blue Shield of California Promise Health Plan complies with applicable State and Federal civil rights laws and does not discriminate on the basis of ancestry, religion, marital status, race, color, national origin, age, disability, or sex/gender, gender identity or sexual orientation. Blue Shield of California Promise Health Plan does not exclude people or treat them differently because of ancestry, religion, marital status, race, color, national origin, age, disability, or sex/gender, gender identity or sexual orientation.

Blue Shield of California Promise Health Plan:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides 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 our Customer Care Operations Department at 1-855-905-3825 (TTY: 711) during 8am-8pm, seven days a week.

If you believe that Blue Shield of California Promise Health Plan has failed to provide these services or discriminated in another way on the basis of ancestry, religion, marital status, race, color, national origin, age, disability, sex/gender, gender identity or sexual orientation, you can file a grievance with the Grievance Coordinator.

Mailing Address:
ATTN: Civil Rights Coordinator
Grievances Department - Blue Shield of California Promise Health Plan
601 Potrero Grande Dr.
Monterey Park, CA 91755
Telephone Number:
1-844-883-2233 (TTY: 711), from 7:00am to 8:00pm, during Monday through Friday
Fax Number: 1-323-889-2228
Email Address: CRC@blueshieldca.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Grievance Coordinator at Blue Shield Promise Health Plan Grievance Department, is available to help you.

Grievances must be submitted to the Appeals and Grievance Department, with Civil Rights Coordinator, within 60 calendar days from the time you have become aware of any alleged discrimination action. A complaint must be in writing, or reported verbally, containing your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.

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, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Such complaints must be filed within 180 days from the date of the alleged discrimination.
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

English:
ATTENTION: Language assistance services, free of charge, are available to you. Call 1-855-905-3825. (TTY: 711).
Հայերեն (Armenian)
ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-855-905-3825 (TTY (հեռատիպ)՝711):
繁體中文 (Chinese):
注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-855-905-3825 (TTY:711) 。
한국어 (Korean):
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-855-905-3825 (TTY: 711)번으로 전화해 주십시오.
Русский (Russian):
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-855-905-3825 (телетайп: 711).
Kreyòl Ayisyen (Haitian-Creole)
ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-855-905-3825 (TTY: 711).
Français (French):
ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-855-905-3825 (TTY: 711).
Português (Portuguese):
ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-855-905-3825 (TTY: 711).
Italiano (Italian):
ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-855-905-3825 (TTY: 711).
فارسی (Farsi):
توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با 1-855-905-3825 (TTY: 771) تماس بگیرید.
हिंदी (Hindi):
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-855-905-3825 (TTY: 711) पर कॉल करें।
Hmong (Hmong):
LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-855-905-3825 (TTY: 711).
Español (Spanish):
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-905-3825 (TTY: 711).
ែខរ (Cambodian)
្របយ័ត ៖ េបើសិនជ‌អ កនិយ‌យ ភា뗈សា⊰ែខ រ, េសវ‌ជំនួយែផ កភា េដ‌យមិនគិតឈ ល គឺឣ‍ចមានសំរ‌ប់បំេរ អ ក។ ចូរ ទូរស័ព 1-800-605-2556 (TTY: 1-855-905-3825)។
Tiếng Việt (Vietnamese):
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-855-905-3825 (TTY: 711).
Tagalog (Tagalog - Filipino):
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-855-905-3825 (TTY: 711).
العربية (Arabic):
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-855-905-3825 (711:YTT)
ພາສາລາວ (Lao):
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-855-905-3825 (TTY: 711).
Polski (Polish):
UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-855-905-3825 (TTY: 711).
Deustch (German):
ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-855-905-3825 (TTY: 711).
日本語 (Japanese):
注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-800-544-0088(TTY:711)まで、お電話にてご連絡ください。
ภาษาไทย (Thai):
เรียน: ถ้าคุณพูดภาษาไทยคุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 1-855-905-3825 (TTY: 711).
Türkçe (Turkish):
DİKKAT: Eğer Türkçe konuşuyor iseniz, dil yardımı hizmetlerinden ücretsiz olarak yararlanabilirsiniz. 1-855-905-3825 (TTY: 711) irtibat numaralarını arayın.
λληνικά (Greek):
ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-855-905-3825 (TTY: 711).
ਪੰਜਾਬੀ ਦੇ (Punjabi):
ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-855-905-3825 (TTY: 711) 'ਤੇ ਕਾਲ ਕਰੋ।
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