CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) 2022

Non-Discrimination Notice

Discrimination is against the law. HPSM follows State and Federal civil rights laws. HPSM 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.

HPSM 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, 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 the CareAdvantage Unit between Monday through Sunday, 8:00 a.m. to 8:00 p.m. by calling 1-866-880-0606. If you cannot hear or speak well, please call TTY 1-800-735-2929 or 7-1-1). Upon request, this document can be made available to you in braille, large print, electronic or audio format. To obtain a copy in one of these alternative formats, please call or write to:

Health Plan of San Mateo
Attn.: CareAdvantage Unit
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080

HOW TO FILE A GRIEVANCE

If you believe that HPSM 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 HPSM. You can file a grievance by phone, in writing, in person, or electronically:

  • By phone: Contact between Monday through Sunday, 8:00 a.m. to 8:00 p.m. by calling 1-866-880-0606. Or, if you cannot hear or speak well, please call TTY 1-800-735-2929 or 7-1-1.
  • In writing: Fill out a complaint form or write a letter and send it to:

Health Plan of San Mateo
Attn.: Grievance and Appeals
801 Gateway Blvd., Suite 100
South San Francisco, CA 94080

  • In person: Visit your doctor’s office or HPSM and say you want to file a grievance.
  • Electronically: Visit HPSM’s website at grievance.hpsm.org

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 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


CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage 2022 Member Handbook.

Benefits and co-pays may change on January 1 of each year.

If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929 or dial 7-1-1). ( Download this statement in multiple languages.)

H7885_Web2022 Accepted

Page updated October 1, 2021