Notice of non-discrimination

Discrimination is against the law. Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) follows State and Federal civil rights laws. 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.

Health Plan provides:

• Free aids and services in a timely manner 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, other formats)

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

If you need these services, contact Health Plan between Monday-Friday 8:00 a.m. – 5:00 p.m. by calling 1-888-936-7526. 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:

Health Plan of San Joaquin/Mountain Valley Health Plan
7751 South Manthey Road, French Camp, CA 95231
1-888-936-7526 TTY 711

If you believe that Health Plan has failed to provide these services or unlawfully discriminated in another way on the basis 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, you can file a grievance with Health Plan’s Customer Service Department. You can file a grievance by phone, in writing, in person, or electronically:

By phone: Contact Health Plan’s Customer Service Department between Monday-Friday, 8:00 a.m.–5:00 p.m. by calling 1-888-936-7526. Or, if you cannot hear or speak well, please call TTY 711.

In writing: Fill out a complaint form or write a letter and send it to:

Health Plan of San Joaquin/Mountain Valley Health Plan
Attn: Grievance and Appeals Department
7751 S. Manthey Road, French Camp, CA 95231

By fax: 1-209-942-6355

In-person: Visit your doctor’s office or Health Plan and say you want to file a grievance.

Electronically: Visit Health Plan’s website at www.hpsj-mvhp.org

If you need help filing a grievance, a Customer Service Representative can help you.

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 1-916-440-7370. If you cannot speak or hear well, please call 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
Office of Civil Rights
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

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

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