Language Assistance + Non-Discrimination Statements

Language assistance

If you want free help translating this information, call the number on the back of your Medica ID card.

አማርኛ

ይህን መረጃ ለመተርጎም ነጻ እርዳታ ከፈለጉ፣ የ Medica መታወቂያ ካርድዎ ጀርባ ላይ ባለው ቁጥር ይደውሉ።

العربیة

إذا كنت تريد مساعدة مجانية في ترجمة هذه المعلومات، فاتصل على الرقم الوارد على ظهر بطاقة Medica.

မြန်မာ 

ဤအချက်အလက်ကို ဘာသာပြန်ရာတွင် အခမဲ့အကူအညီ လိုအပ်ပါက ဤစာရွက်စာတမ်း သို့မဟုတ် သင့် Medica ID ကဒ်ကျောဘက်ရှိ နံပါတ်ကို ခေါ်ဆိုပါ။

ភាសាខ្មែរ 

ប្រសិនបើអ្នកចង់បានជំនួយឥតគិតថ្លៃក្នុងការបកប្រែព័ត៌មាននេះ សូមទូរស័ព្ទមកលេខនៅខាងខ្នងប័ណ្ណ Medica ID របស់អ្នក។

中文 

如果您想得到免费帮助,翻译这些信息,请拨打您 Medica ID 卡背面的电话。

Hrvatski

Ako želite besplatnu pomoć za prijevod ovih informacija, nazovite broj naveden na poleđini vaše Medica identifikacijske kartice.

Français

Si vous voulez une assistance gratuite pour traduire ces informations, appelez le numéro indiqué au dos de votre carte d'identification Medica.

Deutsch 

Wenn Sie bei der Übersetzung dieser Informationen kostenlose Hilfe in Anspruch nehmen möchten, rufen Sie bitte die auf der Rückseite Ihrer Medica-ID-Karte angegebene Nummer an.

Hmoob

Yog hais tias koj xav tau kev pab dawb txog kev muab qhov lus qhia paub no txhais, hu rau tus xov tooj uas nyob rau sab nrob qaum ntawm koj daim npav ID ntawm Medica.

ကညီ

နမ့ၢ်သးအိၣ်လၢပှၤကကွဲးကျိာ်ထံက့ၤန့ၢ်နၤ တၢ်ဂ့ၢ်တၢ်ကျိၤအံၤန့ၣ်, ဆဲးကျိး နီၣ်ဂံၢ်အိၣ်လၢန Medica ID ခး အချၢတကပၤအံၤတက့ၢ်.

한국어

이 정보를 번역하는 데 무료로 도움을 받고 싶으시면, Medica ID 카드 뒷면의 전화번호로 전화하십시오.

ລາວ

ຖ້າທ່ານຕ້ອງການແປຂໍ້ມູນນີ້ຟຣີ, ໂທເຂົ້າເບີໂທທີ່ມີຢູ່ດ້ານຫຼັງບັດ Medica ຂອງທ່ານ.

Diné Bizaad

D77 bee dahane’7 hadilyaa7g77 bee ata’ hane’ bee shika’a’doowo[ n7n7zingo, ni Medica ID naaltsoos ni[t[‘is7 bine’d66’ b44sh bee hane’7 bik1’7g77 bee hod7ilnih.

Oromiffa

Odeeffannoo kana hiikuuf gargaarsa bilisaa yoo barbaaddan, lakkoofsa waraqaa eenyummaa Medica dugda duuba jiruun bilbilaa.

Pусский

Если вам нужна бесплатная помощь в переводе этой информации, позвоните по номеру, указанному на обратной стороне вашей карты Medica.

Af-Soomaali

Haddii aad rabto caawimaad bilaash ah oo ku saabsan tarjumaadda macluumaadkan, wac lambarka ku yaal dhabarka kaarkaaga Aqoonsiga Medica.

Español

Si desea asistencia gratuita para traducir esta información, llame al número que figura en el reverso de su tarjeta de identificación de Medica.

Tagalog

Kung gusto mo ng libreng tulong sa pagsasalin ng impormasyong ito, tawagan ang numero sa likod ng iyong Medica ID card.

Tiếng Việt

Nếu quý vị muốn trợ giúp dịch thông tin này miễn phí, hãy gọi vào số ở mặt sau thẻ ID Medica của quý vị.

Non-discrimination statement

Discrimination is against the law

Medica complies with applicable Federal civil rights laws and will not discriminate against any person based on their race; color; creed; religion, national origin; sex; gender; gender identity; or health status, including mental and physical medical conditions, marital status, familial status, status with regard to public assistance, disability, sexual orientation, age, political beliefs, membership or activity in a local commission, or any other classification protected by law.

Medica:

  • Provides free aids and services to people with disabilities to communicate effectively with us, such as: TTY communication
  • Written information in other formats (large print, audio, other formats)
  • Provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages

If you need these services, contact the number on the back of your identification card. If you believe that Medica has failed to provide these services or discriminated in another way on the basis of your race; color; creed; religion; national origin; sex; gender; gender identity; or health status, including mental and physical medical conditions, marital status, familial status, status with regard to public assistance, disability, sexual orientation, age, political beliefs, membership or activity in a local commission, or any other classification protected by law, you can file a grievance with:

Civil Rights Coordinator
Mail Route CP250
P.O. Box 9310
Minneapolis, MN 55443-9310
952-992-3422 (voice) TTY: 711
civilrightscoordinator@medica.com

You can file a grievance in person or by mail, fax, or email. You may also contact the Civil Rights Coordinator if you need assistance with filing a complaint. 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, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Ave.
SW Room 509F
HHH Building
Washington, D.C. 20201
1-800-368-1019
1-800-537-7697 (TTY)

Medicaid

Medicaid Language Assistance
CB5 (MCOs) (05-2020)

Civil Rights Notice

Discrimination is against the law. Medica does not discriminate on the basis of any of the following:
  • race
  • color
  • national origin
  • creed
  • religion
  • sexual orientation
  • public assistance status
  • age
  • disability (including physical or mental impairment)
  • sex (including sex stereotypes and gender identity)
  • marital status
  • political beliefs
  • medical condition
  • health status
  • receipt of health care services
  • claims experience
  • medical history
  • genetic information
Auxiliary Aids and Services: Medica provides auxiliary aids and services, like qualified interpreters or information in accessible formats, free of charge and in a timely manner to ensure an equal opportunity to participate in our health care programs. Contact Medica at 1-888-347-3630 (toll free), TTY: 711 or at medica.com/contact-us.

Language Assistance Services: Medica provides translated documents and spoken language interpreting, free of charge and in a timely manner, when language assistance services are necessary to ensure limited English speakers have meaningful access to our information and services. Contact Medica at 1-888-347-3630 (toll free), TTY: 711

Civil Rights Complaints

You have the right to file a discrimination complaint if you believe you were treated in a discriminatory way by Medica. You may contact any of the following four agencies directly to file a discrimination complaint.

U.S. Department of Health and Human Services’ Office for Civil Rights (OCR)

You have the right to file a complaint with the OCR, a federal agency, if you believe you have been discriminated against because of any of the following:

  • race
  • color
  • national origin
  • age
  • disability
  • sex
  • religion (in some cases)

Contact the OCR directly to file a complaint:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Ave. S.W.
Room 515F
HHH Building
Washington, D.C. 20201

Customer Response Center: Toll-free: 1-800-368-1019
TDD: 800-537-7697
Email: ocrmail@hhs.gov

Minnesota Department of Human Rights (MDHR)

In Minnesota, you have the right to file a complaint with the MDHR if you believe you have been discriminated against because of any of the following:
  • race
  • color
  • national origin
  • religion
  • creed
  • sex
  • sexual orientation
  • marital status
  • public assistance status
  • disability

Contact the MDHR directly to file a complaint:

Minnesota Department of Human Rights
540 Fairview Ave. N.
Suite 201
St. Paul, MN 55104
651-539-1100 (voice)
1-800-657-3704 (toll free)
711 or 1-800-627-3529 (MN Relay)
651-296-9042 (fax)
Email: info.MDHR@state.mn.us

Minnesota Department of Human Services (DHS)

You have the right to file a complaint with DHS if you believe you have been discriminated against in our health care programs because of any of the following:

  • race
  • color
  • national origin
  • creed
  • religion
  • sexual orientation
  • public assistance status
  • age
  • disability (including physical or mental impairment)
  • sex (including sex stereotypes and gender identity)
  • marital status
  • political beliefs
  • medical condition
  • health status
  • receipt of health care services
  • claims experience
  • medical history
  • genetic information

Complaints must be in writing and filed within 180 days of the date you discovered the alleged discrimination. The complaint must contain your name and address and describe the discrimination you are complaining about. After we get your complaint, we will review it and notify you in writing about whether we have authority to investigate. If we do, we will investigate the complaint.

DHS will notify you in writing of the investigation’s outcome. You have the right to appeal the outcome if you disagree with the decision. To appeal, you must send a written request to have DHS review the investigation outcome. Be brief and state why you disagree with the decision. Include additional information you think is important.

If you file a complaint in this way, the people who work for the agency named in the complaint cannot retaliate against you. This means they cannot punish you in any way for filing a complaint. Filing a complaint in this way does not stop you from seeking out other legal or administrative actions.

Contact DHS directly to file a discrimination complaint:

Civil Rights Coordinator
Minnesota Department of Human Services
Equal Opportunity and Access Division
P.O. Box 64997
St. Paul, MN 55164-0997
651-431-3040 (voice) or use your preferred relay service

Medica Complaint Notice

You have the right to file a complaint with Medica if you believe you have been discriminated against because of any of the following:

  • medical condition
  • health status
  • receipt of health care services
  • claims experience
  • medical history
  • genetic information
  • disability (including mental or physical impairment)
  • marital status
  • age
  • sex (including sex stereotypes and gender identity)
  • sexual orientation
  • national origin
  • race
  • color
  • religion
  • creed
  • public assistance status
  • political beliefs

You can file a complaint and ask for help in filing a complaint in person or by mail, phone, fax, or email at:

Medica Civil Rights Coordinator
Medica Health Plans
P.O. Box 9310, Mail Route CP250
Minneapolis, MN 55443-9310
952-992-3422 (voice and fax) TTY: 711
Email: civilrightscoordinator@medica.com

American Indians can continue or begin to use tribal and Indian Health Services (IHS) clinics. We will not require prior approval or impose any conditions for you to get services at these clinics. For elders age 65 years and older this includes Elderly Waiver (EW) services accessed through the tribe. If a doctor or other provider in a tribal or IHS clinic refers you to a provider in our network, we will not require you to see your primary care provider prior to the referral.

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