Discrimination is Against the Law Getting Help in Other Languages Premera Blue Cross complies with applicable Federal civil rights laws and does not discriminate on the basis of This Notice has Important Information. This notice may race, color, national origin, age, disability, or have important information about your application or sex. Premera does not exclude people or treat them coverage through Premera Blue Cross. There may be differently because of race, color, national origin, age, key dates in this notice. You may need to take action by disability or sex. certain deadlines to keep your health coverage or help Premera: with costs. You have the right to get this information and • Provides free aids and services to people with help in your language at no cost. Call 1-800-722-1471 disabilities to communicate effectively with us, such as: (TTY: 1-800-842-5357). • Qualified sign language interpreters • Written information in other formats (large print, audio, አማሪኛ (Amharic): accessible electronic formats, other formats) ይህ ማስታወቂያ አስፈላጊ መረጃ ይዟል። ይህ ማስታወቂያ ስለ • Provides free language services to people whose ማመልከቻዎ ወይም የ Premera Blue Cross ሽፋን አስፈላጊ primary language is not English, such as: መረጃ ሊኖረው ይችላል። በዚህ ማስታወቂያ ውስጥ ቁልፍ ቀኖች • Qualified interpreters ሊኖሩ ይችላሉ። የጤናን ሽፋንዎን ለመጠበቅና በአከፋፈል እርዳታ • Information written in other languages ለማግኘት በተውሰኑ የጊዜ ገደቦች እርምጃ መውሰድ ይገባዎት ይሆናል። ይህን መረጃ እንዲያገኙ እና ያለምንም ክፍያ በቋንቋዎ እርዳታ እንዲያገኙ መብት አለዎት።በስልክ ቁጥር 1-800-722- If you need these services, contact the Civil Rights 1471 (TTY: 1-800-842-5357) ይደውሉ። Coordinator. If you believe that Premera has failed to provide these ةيبرعلا (Arabic): services or discriminated in another way on the basis of تامولعم راعشلإا اذه يوحي دق .ةماه تامولعم راعشلإا اذه يوحي race, color, national origin, age, disability, or sex, you can لوصحلا ديرت يتلا ةيطغتلا وأ كبلط صوصخب ةمهم file a grievance with: خيراوت كانه نوكت دق . Premera Blue Cross للاخ نم اهيلع Civil Rights Coordinator ─ Complaints and Appeals ةنيعم خيراوت يف ءارجإ ذا ختلا جاتحت دق و .راعشلإا اذه يف ةمهم PO Box 91102, Seattle, WA 98111 كل قحي .فيلاكتلا عفد يف ةدعاسملل وأ ةيحصلا كتيطغت ىلع ظافحلل Toll free 855-332-4535, Fax 425-918-5592, .ةفلكت ةيأ دب كت نود كتغلب ةدعاسملاو تامولعملا هذه ىلع لوصحلا TTY 800-842-5357 ـب لصتا Email [email protected] 1-800-722-1471 (TTY: 1-800-842-5357) You can file a grievance in person or by mail, fax, or 中文 (Chinese): email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. 本通知有重要的訊息。本通知可能有關於您透 過 Premera Blue Cross 提交的申請或保險的重要訊 You can also file a civil rights complaint with the U.S. 息。本通知內可能有重要日期。您可能需要在截 Department of Health and Human Services, Office for 止日期之前採取行動，以保留您的健康保險或者 Civil Rights, electronically through the Office for Civil 費用補貼。您有權利免費以您的母語得到本訊息 Rights Complaint Portal, available at 和幫助。請撥電話 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or 1-800-722-1471 (TTY: 1-800-842-5357)。 phone at: U.S. Department of Health and Human Services, Oromoo (Cushite): 200 Independence Ave SW, Room 509F, HHH Building • Washington, D.C. 20201, 1-800-368-1019, Beeksisni kun odeeffannoo barbaachisaa qaba. Beeksisti kun sagantaa yookan karaa Premera Blue 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. Cross tiin tajaajila keessan ilaalchisee odeeffannoo barbaachisaa qabaachuu danda’a. Guyyaawwan murteessaa ta’an beeksisa kana keessatti ilaalaa. Tarii kaffaltiidhaan deeggaramuuf yookan tajaajila fayyaa keessaniif guyyaa dhumaa irratti wanti raawwattan jiraachuu danda’a. Kaffaltii irraa bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabaattu. Lakkoofsa bilbilaa 1-800-722-1471 (TTY: 1-800-842-5357) tii bilbilaa.