HomeMy WebLinkAboutKaiser HMO 15 Summary of Benefits and CoverageSummary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2025-12/31/2025
:TRADITIONAL PLAN Coverage for: Individual/Family | Plan Type: HMO
The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan
would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided
separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage see
https://kp.org/plandocuments or call 1-800-278-3296 (TTY: 711). For general definitions of common terms, such as allowed amount, balance billing, coinsurance,
copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at www.healthcare.gov/sbc-glossary/ or call
1-800-278-3296 (TTY: 711) to request a copy.
Important Questions Answers Why this Matters:
What is the overall deductible?$0 See the Common Medical Events chart below for your costs for services this plan covers.
Are there services covered before you meet your deductible?Not Applicable.
This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other deductibles for specific services?No. You don’t have to meet deductibles for specific services.
What is the out-of-pocket limit for this plan?$1,500 Individual / $3,000 Family The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in the out-of-pocket limit?Premiums, health care this plan doesn't cover, and services indicated in chart starting on page 2.Even though you pay these expenses, they don't count toward the out-of-pocket limit.
Will you pay less if you use a network provider?Yes. See www.kp.org or call 1-800-278-3296 (TTY: 711) for a list of network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to see a specialist?Yes, but you may self-refer to certain specialists. This plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.
PRISM - SDRMA/GSRMA SOUTH
PID:233392 CNTR:1 EU:0 Plan ID:2794 SBC ID:574331 1 of 6
All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies.
CommonMedical Event Services You May Need
What You Will PayPlan Provider(You will pay the least)
What You Will PayNon-Plan Provider(You will pay the most)
Limitations, Exceptions & Other Important Information
If you visit a health care provider's office or clinic
Primary care visit to treat an injury or illness $15 / visit Not Covered None
Specialist visit $15 / visit Not Covered None
Preventive care/screening/immunization No Charge Not Covered
You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
If you have a test
Diagnostic test (x-ray, blood work)No Charge Not Covered None
Imaging (CT/PET scans, MRI's)No Charge Not Covered None
If you need drugs to treat your illness or conditionMore information about prescription drug coverage is available at www.kp.org/formulary
Generic drugs (Tier 1)Retail: $5 / prescription; Mail order: $10 / prescription Not Covered Up to a 30-day supply retail or 100-day supply mail order. Subject to formulary guidelines. No Charge for Contraceptives.
Preferred brand drugs (Tier 2)Retail: $20 / prescription; Mail order: $40 / prescription Not Covered Up to a 30-day supply retail or 100-day supply mail order. Subject to formulary guidelines.
Non-preferred brand drugs (Tier 2)Retail: $20 / prescription; Mail order: $40 / prescription Not Covered
The cost sharing for non-preferred brand drugs under this plan aligns with the cost sharing for preferred brand drugs (Tier 2), when approved through the formulary exception process.
Specialty drugs (Tier 4)$20 / prescription Not Covered Up to a 30-day supply retail. Subject to formulary guidelines.
If you have outpatient surgery
Facility fee (e.g., ambulatory surgery center)$15 / procedure Not Covered None
Physician/surgeon fees No Charge Not Covered Physician/surgeon fees are included in the Facility fee.
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CommonMedical Event Services You May Need
What You Will PayPlan Provider(You will pay the least)
What You Will PayNon-Plan Provider(You will pay the most)
Limitations, Exceptions & Other Important Information
If you need immediate medical attention
Emergency room care $50 / visit $50 / visit None
Emergency medical transportation No Charge No Charge None
Urgent care $15 / visit Not Covered Non-Plan providers covered when temporarily outside the service area: $15 / visit.
If you have a hospital stay
Facility fee (e.g., hospital room)No Charge Not Covered None
Physician/surgeon fee No Charge Not Covered None
If you need mental health, behavioral health, or substance abuse services
Outpatient services $15 / individual visit. No Charge for other outpatient services Not Covered Mental / Behavioral Health: $7 / group visit; Substance Abuse: $5 / group visit.
Inpatient services No Charge Not Covered None
If you are pregnant
Office visits No Charge Not covered
Depending on the type of services, a copayment, coinsurance, or deductible may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services No Charge Not Covered None
Childbirth/delivery facility services No Charge Not Covered None
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CommonMedical Event Services You May Need
What You Will PayPlan Provider(You will pay the least)
What You Will PayNon-Plan Provider(You will pay the most)
Limitations, Exceptions & Other Important Information
If you need help recovering or have other special health needs
Home health care No Charge Not Covered 3 visit limit / day, 4-hour limit / visit, 100 visit limit / year.
Rehabilitation services Inpatient: No Charge; Outpatient: $15 / visit Not Covered None
Habilitation services $15 / visit Not Covered None
Skilled nursing care No Charge Not Covered 100 day limit / benefit period.
Durable medical equipment No Charge Not Covered Requires prior authorization.
Hospice service No Charge Not Covered None
If your child needs dental or eye care
Children's eye exam No Charge for refractive exam Not Covered None
Children's glasses Not Covered Not Covered None
Children's dental check-up Not Covered Not Covered None
Excluded Services & Other Covered Services:
Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
●Children's glasses●Cosmetic surgery●Dental Care (Adult & Child)
●Hearing aids●Long-term care●Non-emergency care when traveling outside the U.S.
●Private-duty nursing●Routine foot care●Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
●Acupuncture (30 visit limit / year combined with chiropractic)●Bariatric surgery
●Chiropractic care (30 visit limit / year combined with acupuncture)●Infertility treatment
●Routine eye care (Adult)
Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is shown in the chart below. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.
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Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explanation of benefits you will receive for that medical claim. Your plan documents also provide complete information on how to submit a claim, appeal, or a grievance for any reason to your plan. For more information about your rights, this notice, or assistance, contact the agencies in the chart below.
Contact Information for Your Rights to Continue Coverage & Your Grievance and Appeals Rights:
Kaiser Permanente Member Services 1-800-278-3296 (TTY: 711) or www.kp.org/memberservices
Department of Labor’s Employee Benefits Security Administration 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform
Department of Health & Human Services, Center for Consumer Information & Insurance Oversight 1-877-267-2323 x61565 or www.cciio.cms.gov
California Department of Insurance 1-800-927-HELP (4357) or www.insurance.ca.gov
California Department of Managed Healthcare 1-888-466-2219 or www.dmhc.ca.gov
Does this plan provide Minimum Essential Coverage? Yes.
Minimum Essential Coverage generally includes plans, health insurance available through the Marketplace or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage, you may not be eligible for the premium tax credit.
Does this plan meet the Minimum Value Standards? Yes.
If your plan doesn’t meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.
Language Access Services:SPANISH (Español): Para obtener asistencia en Español, llame al 1-800-788-0616 (TTY: 711)
TAGALOG (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-278-3296 (TTY: 711)
TRADITIONAL CHINESE (中文): 如果需要中文的帮助，请拨打这个号码 1-800-757-7585 (TTY: 711)
PENNSYLVANIA DUTCH (Deitsch): Fer Hilf griege in Deitsch, ruf 1-800-278-3296 (TTY: 711) uff
NAVAJO (Dine): Dinek'ehgo shika at'ohwol ninisingo, kwiijigo holne' 1-800-278-3296 (TTY: 711)
SAMOAN (Gagana Samoa): Mo se fesoasoani i le Gagana Samoa, vala’au mai i le numera telefoni 1-800-278-3296 (TTY: 711)
CAROLINIAN (Kapasal Falawasch): ngere aukke ghut alillis reel kapasal Falawasch au fafaingi tilifon ye 1-800-278-3296 (TTY: 711)
CHAMORRO (Chamoru): Para un ma ayuda gi finu Chamoru, ȧ'gang 1-800-278-3296 (TTY: 711)
To see examples of how this plan might cover costs for a sample medical situation, see the next section.
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About these Coverage Examples:
This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost sharing amounts (deductibles, copayments and coinsurance) and excluded services under the plan. Use this information to compare the portion of costs you might pay under different health plans. Please note these coverage examples are based on self-only coverage.
Peg is Having a Baby(9 months of in-network pre-natal care and a hospital delivery)
The plan's overall deductible
Specialist copayment
Hospital (facility) copayment Other (blood work) copayment
$0
$15
$0
$0
This EXAMPLE event includes services like:Specialist office visits (prenatal care)Childbirth/Delivery Professional ServicesChildbirth/Delivery Facility ServicesDiagnostic tests (ultrasounds and blood work)Specialist visit (anesthesia)
Total Example Cost $12,700
In this example, Peg would pay:
Cost Sharing
Deductibles $0
Copayments $10
Coinsurance $0
What isn't covered
Limits or exclusions $50
The total Peg would pay is $60
Managing Joe's Type 2 Diabetes(a year of routine in-network care of a well-controlled condition)
The plan's overall deductible
Specialist copayment
Hospital (facility) copayment Other (blood work) copayment
$0
$15
$0
$0
This EXAMPLE event includes services like:Primary care physician office visits (including disease education)Diagnostic tests (blood work)Prescription drugsDurable medical equipment (glucose meter)
Total Example Cost $5,600
In this example, Joe would pay:
Cost Sharing
Deductibles $0
Copayments $500
Coinsurance $0
What isn't covered
Limits or exclusions $0
The total Joe would pay is $500
Mia's Simple Fracture(in-network emergency room visit and follow up care)
The plan's overall deductible
Specialist copayment
Hospital (facility) copayment Other (x-ray) copayment
$0
$15
$0
$0
This EXAMPLE event includes services like:Emergency room care (including medical supplies)Diagnostic test (x-ray)Durable medical equipment (crutches)Rehabilitation services (physical therapy)
Total Example Cost $2,800
In this example, Mia would pay:
Cost Sharing
Deductibles $0
Copayments $100
Coinsurance $0
What isn't covered
Limits or exclusions $0
The total Mia would pay is $100
The plan would be responsible for the other costs of these EXAMPLE covered services.
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¹ Kaiser Permanente is inclusive of Kaiser Foundation Health Plan, Inc, Kaiser Foundation Hospitals, The Permanente Medical Group, and the Southern California Medical Group Nondiscrimination Notice
Discrimination is against the law. Kaiser Permanente¹ follows State and Federal civil rights laws.
Kaiser Permanente does not unlawfully discriminate, exclude people, or treat them differently because of age, race, ethnic group identification, color, national origin, cultural background, ancestry, religion, sex, gender, gender identity, gender expression, sexual orientation, marital status, physical or mental disability, medical condition, source of payment, genetic information, citizenship, primary language, or immigration status.
Kaiser Permanente provides the following services:
●No-cost aids and services to people with disabilities to help them communicate better with us, such as:
♦Qualified sign language interpreters
♦Written information in other formats (braille, large print, audio, accessible electronic formats, and other formats)
●No-cost language services to people whose primary language is not English, such as:
♦Qualified interpreters
♦Information written in other languages
If you need these services, call our Member Service Contact Center, 24 hours a day, 7 days a week (closed holidays). The call is free:
●Medi-Cal: 1-855-839-7613 (TTY 711)●All others: 1-800-464-4000 (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, or another format, call our Member Service Contact Center and ask for the format you need.
How to file a grievance with Kaiser Permanente
You can file a discrimination grievance with Kaiser Permanente if you believe we have failed to provide these services or unlawfully discriminated in another way. You can file a grievance by phone, by mail, in person, or online. Please refer to your Evidence of Coverage or Certificate of Insurance for details. You can call Member Services for more information on the options that apply to you, or for help filing a grievance. You may file a discrimination grievance in the following ways:
●By phone: Medi-Cal members may call 1-855-839-7613 (TTY 711). All other members may call 1-800-464-4000 (TTY 711). Help is available 24 hours a day, 7 days a week (closed holidays)
●By mail: Download a form at kp.org or call Member Services and ask them to send you a form that you can send back.
¹ Kaiser Permanente is inclusive of Kaiser Foundation Health Plan, Inc, Kaiser Foundation Hospitals, The Permanente Medical Group, and the Southern California Medical Group
●In person: Fill out a Complaint or Benefit Claim/Request form at a member services office located at a Plan Facility (go to your provider directory at kp.org/facilities for addresses)
●Online: Use the online form on our website at kp.org
You may also contact the Kaiser Permanente Civil Rights Coordinator directly at the addresses below:
Attn: Kaiser Permanente Civil Rights CoordinatorMember Relations Grievance OperationsP.O. Box 939001San Diego CA 92193
How to file a grievance with the California Department of Health Care Services Office of Civil Rights (For Medi-Cal Beneficiaries Only)
You can also file a civil rights complaint with the California Department of Health Care Services Office of Civil Rights in writing, by phone or by email:
●By phone: Call DHCS Office of Civil Rights at 916-440-7370 (TTY 711)
●By mail: Fill out a complaint form or send a letter to:Deputy Director, Office of Civil RightsDepartment of Health Care ServicesOffice of Civil RightsP.O. Box 997413, MS 0009Sacramento, CA 95899-7413
Complaint forms are available at: http://www.dhcs.ca.gov/Pages/Language_Access.aspx
●Online: Send an email to CivilRights@dhcs.ca.gov
How to file a grievance with the U.S. Department of Health and Human Services Office of Civil Rights
You can file a discrimination complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You can file your complaint in writing, by phone, or online:
●By phone: Call 1-800-368-1019 (TTY 711 or 1-800-537-7697)
●By mail: Fill out a complaint form or send a letter to:U.S. Department of Health and Human Services200 Independence Avenue, SWRoom 509F, HHH BuildingWashington, D.C. 20201
Complaint forms are available at:https://www.hhs.gov/ocr/complaints/index.html
●Online: Visit the Office of Civil Rights Complaint Portal at:https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.
Language Assistance Services
English: Language assistance is available at no cost to you, 24 hours a day, 7
days a week. You can request interpreter services, or materials translated into
your language, or in alternative formats. You can also request auxiliary aids
and devices at our facilities. Call our Member Service Contact Center for help,
24 hours a day, 7 days a week (closed holidays).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●All others: 1-800-464-4000 (TTY 711)
:Arabic تامدخ ةمجرتلا ةيروفلا ةرفوتم كل اًناجم ىلع رادم ةعاسلا ةفاك مايأ عوبسألا .كناكمإب بلط ةمدخ ةمجرتلا ةيروفلا وأ ةمجرت قئاثو كتغلل وأ غيصل ىرخأ .كنكمي ًاضيأ بلط تادعاسم ةيفاضإ ةزهجأو يف انقفارم .لصتا عم زكرم لاصتا ةمدخ ءاضعألا ،انيدل ىلع رادم 24 ةعاس يف مويلا و 7مايأ يف عوبسألا) تالطعلا قلغم.(
(TTY 711) 1-855-839-7613 :Medi-Cal ● ●عيمج نيرخآلا :(TTY 711) 1-800-464-4000
Armenian: Ձեզ կարող է անվճար լեզվական աջակցություն տրամադրվել օրը 24 ժամ, շաբաթը 7 օր: Դուք կարող եք պահանջել բանավոր թարգմանչի ծառայություններ, Ձեր լեզվով թարգմանված կամ այլընտրանքային ձևաչափով պատրաստված նյութեր: Դուք նաև կարող եք խնդրել օժանդակ օգնություններ և սարքեր մեր հաստատություններում: Օգնության համար զանգահարեք մեր Անդամների սպասարկման կապի կենտրոն օրը 24 ժամ, շաբաթը 7 օր (տոն օրերին փակ է):
●Medi-Cal` 1-855-839-7613 (TTY 711)
●Այլ` 1-800-464-4000 (TTY 711)
Chinese: 我们每周 7 天，每天 24 小时免费提供语言帮助。您可以要求提供口译员、或将材料翻译为您所用语言或其他格式。您还
可以在我们的设施中要求使用辅助工具和设备。请打电话给我们的会员服务联络中心，服务时间为每周 7 天，每天 24 小时（节假日
除外）。
●所有会员：1-800-757-7585 (TTY 711)
:Farsi تامدخ ینابز رد 24 تعاس هنابشزور و 7 زور هتفه هبتروص ناگيار رد رايتخا تسامش .یمديناوت تامدخ مجرتم ،یهافش اي همجرت کرادم هب نابز دوخ اي هب تمرفیاه
رگيد ار تساوخرد دينک .نينچمه یمديناوت هاگتسداه و کمکیاه رگيد ار رد زکارم ام تساوخرد دييامن .یارب تفايرد ،کمک رد 24 تعاس هنابشزور و 7 زور هتفه) هبزج
تاليطعت (اب زکرم سامت تامدخ یاضعا ام سامت ديريگب.
(TTY 711) 1-855-839-7613 :Medi-Cal ●
● رياس: 1-800-464-4000 )TTY 711(
Hindi: बिना किसी लागत िे भाषा सहायता, दिन िे 24 घंटे, सप्ताह िे सातों दिन उपलब्ध हैं। आप िुभाषषये िी सेवाओं िे ललए, या बिना किसी लागत िे सामग्रियों िो अपनी भाषा में अनुवाि िरवाने िे ललए, या वैिल्पपि प्रारूपों िा अनुरोध िर सिते हैं। आप हमारे सुषवधा-
स्थलों में सहायि साधनों और उपिरणों िे ललए भी अनुरोध िर सिते हैं।सहायता िे ललए हमारी सिस्य सेवाओं िे सम्पि्क िेंद्र िो, दिन िे 24 घंटे, सप्ताह िे सातों दिन (छुद्टियों वाले दिन िंि रहता है) िॉल िरें।
●Medi-Cal: 1-855-839-7613 (TTY 711)
●िािी िूसरे: 1-800-464-4000 (TTY 711)
Hmong: Muaj kev pab txhais lus pub dawb rau koj, 24 teev tuaj ib hnub twg, 7 hnub tuaj ib lim tiam twg. Koj thov tau cov kev pab
txhais lus, muab cov ntaub ntawv txhais ua koj hom lus, los yog ua lwm hom. Koj kuj thov tau lwm yam kev pab thiab khoom siv
hauv peb tej tsev hauj lwm. Hu rau peb Qhov Chaw Pab Cov Tswv Cuab 24 teev tuaj ib hnub twg, 7 hnub tuaj ib lim tiam twg (cov
hnub caiv kaw).
●Medi-Cal: 1-855-839-7613 (TTY 711)●Dua lwm cov: 1-800-464-4000 (TTY 711)
Japanese: 多言語による情報支援を無料で 24 時間年中無休でご利用いただけます。通訳サービス、日本語に翻訳された資料、あ
るいは別の形式による資料もご所望いただけます。また、当施設における補助的な支援や機器についてもご所望いただけます。お気軽にご連絡ください（祝祭日を除き 24 時間週 7 日）。
●Medi-Cal: 1-855-839-7613 (TTY 711)
●その他のご連絡先: 1-800-464-4000 (TTY 711)
Khmer (Cambodian): ជំនួយភាសា គឺឥតគិតថ្លៃដល់អ្នកឡEយយ 24 ឡ៉úងកក្នងកួួយថ្ងៃ 7 ថ្ងៃក្នងកួួយសប្ឌងហ៍។ អ្នកអាចឡស្នយសំំឡសអអ្នកកក្រែក ក្ញឯកសារ្រដលបនកក្រែក ជាភាសា្រ្មែរ ឬទែួក់ជំនួសឡ្ងេកៗឡទតត។ អ្នកក៏អាចឡស្នយសំំបកករ៍៍និកករក្ខាងរជំនួយ ទំនាក់ទំនកសែ៉ក់អ្នកពិ្ខរឡៅទីតាំករកស់ឡយយក្ក្រដរ។ ទូរស័ព្ទឡៅួជងឈួ៍្តល ទំនាក់ទំនកឡសអកួមែស៉ជិករកស់ឡយយកសែ៉ក់ជំនួយ 24 ឡ៉úងកក្នងកួួយថ្ងៃ 7 ថ្ងៃក្នងកួួយសប្ឌងហ៍ (ថ្ងៃឈក់សែ៉កកិទ)។
●Medi-Cal: 1-855-839-7613 (TTY 711)
●ឡ្ងេកឡទតតំំកសស់: 1-800-464-4000 (TTY 711)
Korean: 요일 및 시간에 관계없이 언어지원 서비스를 무료로 이용하실 수 있습니다. 귀하는 통역 서비스 또는 귀하의 언어로 번역
된 자료 또는 대체 형식의 자료를 요청할 수 있습니다. 또한 저희 시설에서 보조기구 및 기기를 요청하실 수 있습니다. 저희 가입자 서비스 연락 센터에 주 7 일, 하루 24 시간(공휴일 휴무) 전화하셔서 도움을 받으십시오.
●Medi-Cal: 1-855-839-7613 (TTY 711)
●기타 모든 경우: 1-800-464-4000 (TTY 711)
Laotian: ມ ີການຊ່ວຍເຫຼືອດ້ານພາສາບໍ່ເສຍຄ່າໃຫ້ແກ່ທ່ານ, 24 ຊົ່ວໂມງຕໍ່ວ ັນ, 7 ວັນຕໍ່ອາທິດ. ທ່ານຍັງສາມາດຂໍບໍລິການຜູ້ແປພາສາ ຫຼື ເອກະສານທີ່ແປເປັນພາສາຂອງທ່ານ ຫຼື ໃນຮູບແບບອື່ນໄດ້. ທ່ານຍ ັງສາມາດຂໍອຸປະກອນຊ່ວຍເສີມ ແລະ ເຄື່ອງມືຢູ່ສະຖານບໍລິການຂອງພວກເຮົາໄດ້. ໂທຫາສູນຕິດຕໍ່ບໍລິການສະມາຊິກຂອງພວກເຮົາເພື່ອຂໍຄວາມຊ່ວຍເຫຼືອ, 24 ຊ ົ່ວໂມງຕໍ່ວ ັນ, 7 ວ ັນຕໍ່ອາທິດ (ປິດໃນວ ັນພັກ).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●ອື່ນໆທັງໝົດ: 1-800-464-4000 (TTY 711)
Mien: Mbenc nzoih liouh wangv-henh tengx nzie faan waac bun muangx meih maiv cingv, yietc hnoi mbenc maaih 24 norm ziangh
hoc, yietc norm leiz baaix mbenc maaih 7 hnoi. Meih se haih tov heuc tengx faan benx meih nyei waac bun muangx, a’fai zoux
benx nyungc horngh jaa-sic zoux benx meih nyei waac. Meih corc haih tov tengx nyungc horngh jaa-dorngx aengx caux jaa-sic
nzie bun yiem njiec zorc goux baengc zingh gorn zangc. Beiv hnangv qiemx zuqc longc mienh nzie weih nor douc waac lorx taux yie mbuo ziux goux baengc mienh nyei gorn zangc, yietc hnoi tengx duqv 24 norm ziangh hoc, yietc norm leiz baaix tengx duqv 7 hnoi (simv cuotv gingc nyei hnoi se guon oc).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●Yietc zungv da’nyeic deix: 1-800-464-4000 (TTY 711)
Navajo: Díí hózhó nízhoní bee hane’ dóó jíik’ah jóóní doonílwo’. Ndik’é yádi naaltsoos bee haz’áanii bee hane’ dóó yádi nihookaa dóó nádááhágíí yádi nihookaa. Shí éí bee háídínii bibee’ haz’áanii dóó bee t’ah kodí bízíkinii wo’da’gi doolyé. Ahéhee’ bik’ehgo nohólǫǫn’ígíí, 24 t’áádawołíí, 7 t’áádawołíígo (t’áadoo t’áálwo’).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●Yadilzingo biłk’ehgo bee: 1-800-464-4000 (TTY 711)
Punjabi: ਬਿਨੈਂ ਬਿਸੀ ਲਾਗਤ ਦੇ, ਬਦਨ ਦੇ 24 ਘੰਟੇ, ਹਫਤੇ ਦੇ 7 ਬਦਨ, ਭਾਸ਼ਾ ਸਹਾਇਤਾ ਤੁਹਾਡੇ ਲਈ ਉਪਲਿਧ ਹੈ। ਤੁਸੇਂ ਦੁਭਾਸ਼ੀਏ ਦੀਆਂ ਸੇਵਾਵੈਂ ਲਈ, ਜੈਂ ਸਮੱਗਰੀਆਂ ਨੂੰ ਆਪਣੀ ਭਾਸ਼ਾ ਬਵੱਚ ਅਨੁਵਾਦ ਿਰਵਾਉਣ ਲਈ, ਜੈਂ ਬਿਸੇ ਵੱਖ ਫਾਰਮੈਟ ਬਵੱਚ ਪ੍ਰਾਪਤ ਿਰਨ ਲਈ ਿੇਨਤੀ ਿਰ ਸਿਦੇ ਹੋ। ਤੁਸੇਂ ਸਾਡੀਆਂ ਸੁਬਵਧਾਵੈਂ ਬਵੱਚ ਵੀ ਸਹਾਇਿ ਸਾਧਨੈਂ ਅਤੇ ਉਪਿਰਣੈਂ ਲਈ ਿੇਨਤੀ ਿਰ ਸਿਦੇ ਹੈਂ। ਮਦਦ ਲਈ ਸਾਡੀ ਮਾਂਿਰ ਸੇਵਾਵੈਂ ਦੇ ਸੰਪਰਿ ਿੀਂਦਰ ਨੂੰ, ਬਦਨ ਦੇ 24 ਘੰਟੇ, ਹਫਤੇ ਦੇ 7 ਬਦਨ (ਛੁੱਟੀਆਂ ਵਾਲੇ ਬਦਨ ਿੰਦ ਰਬਹੰਦਾ ਹੈ) ਿਾੱਲ ਿਰੋ।
●Medi-Cal: 1-855-839-7613 (TTY 711)
●ਹੋਰ ਸਾਰੇ: 1-800-464-4000 (TTY 711)
Russian: Языковая помощь доступна для вас бесплатно круглосуточно, ежедневно. Вы можете запросить услуги переводчика или материалы, переведенные на ваш язык или в альтернативные форматы. Вы также можете заказать вспомогательные средства и приспособления. Для получения помощи позвоните в наш центр обслуживания участников ежедневно, круглосуточно (кроме праздничных дней).
●Medi-Cal: 1-855-839-7613 (линия TTY 711)
●Все остальные: 1-800-464-4000 (линия TTY 711)
Spanish: Tenemos disponible asistencia en su idioma sin ningún costo para usted 24 horas al día, 7 días a la semana. Usted puede solicitar los servicios de un intérprete, que los materiales se traduzcan a su idioma o formatos alternativos. También puede solicitar recursos para discapacidades en nuestros centros de atención. Llame a nuestra Central de Llamadas de Servicio a los Miembros para recibir ayuda 24 horas al día, 7 días a la semana (excepto los días festivos).
●Para todos los demás: 1-800-788-0616 (TTY 711)
Tagalog: May magagamit na tulong sa wika nang wala kayong babayaran, 24 na oras sa isang araw, 7 araw sa isang linggo. Maaari kayong humiling ng mga serbisyo ng interpreter, o mga babasahin na isinalin sa inyong wika o sa mga alternatibong format. Maaari rin kayong humiling ng mga pantulong na gamit at device sa aming mga pasilidad. Tawagan ang aming Center sa Pakikipag-ugnayan ng Serbisyo sa Miyembro para sa tulong, 24 na oras sa isang araw, 7 araw sa isang linggo (sarado sa mga pista opisyal).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●Lahat ng iba pa: 1-800-464-4000 (TTY 711)
Thai: มีบริการช่วยเหลือด้านภาษาตลอด 24 ชั่วโมงทุกวันโดยไม่มีค่าใช ้จ่าย โดยคุณสามารถขอใช ้บริการล่าม บริการแปลเอกสารเป็นภาษาของคุณหรือในรูปแบบอื่นๆ ได้ คุณสามารถขออุปกรณ์และเครื่องมือช่วยเหลือได้ที่ศูนย์บริการของเราโดยโทรหาเราที่ศูนย์ติดต่อฝ่ายบริการสมาชิกของเราเพื่อขอความช่วยเหลือตลอด 24 ชั่วโมงทุกวัน (ปิดทําการในช่วงวันหยุด)
●Medi-Cal: 1-855-839-7613 (TTY 711)
●ที่อื่นๆทั้งหมด: 1-800-464-4000 (TTY 711)
Ukranian: Послуги перекладача надаються безкоштовно, цілодобово, 7 днів на тиждень. Ви можете зробити запит на послуги усного перекладача або отримання матеріалів у перекладі мовою, якою володієте, чи в альтернативних форматах. Також ви можете зробити запит на отримання допоміжних засобів і пристроїв у закладах нашої мережі компаній. Телефонуйте в наш контактний центр для обслуговування клієнтів цілодобово, 7 днів на тиждень (крім святкових днів).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●Усі інші: 1-800-464-4000 (TTY 711)
Vietnamese: Dịch vụ hỗ trợ ngôn nữ được cung cấp miễn phí cho quý vị 24 giờ mỗi ngày, 7 ngày trong tuần. Quý vị có thể yêu cầu dịch vụ thông dịch, hoặc tài liệu được dịch ra ngôn ngữ của quý vị hoặc nhiều hình thức khác. Quý vị cũng có thể yêu cầu các phương tiện trợ giúp và thiết bị bổ trợ tại các cơ sở của chúng tôi. Gọi cho Trung Tâm Liên Lạc ban Dịch Vụ Hội Viên của chúng tôi để được trợ giúp, 24 giờ mỗi ngày, 7 ngày trong tuần (trừ các ngày lễ).
●Medi-Cal: 1-855-839-7613 (TTY 711)
●Mọi chương trình khác: 1-800-464-4000 (TTY 711)