Área de Servicio Service Area/

1 What you need to know about your benefitsKFHC Combined Evidence of Coverage (EOC) and Disclosure Form Service area / rea de Servicio2021031 Rev. 03/2021 Alta Sierra Arvin Bakersfield Bear Valley Springs Bodfish Boron Buttonwillow Caliente California City Delano Di Giorgio EdisonEdwards AFB Fellows Frazier ParkGlennville Havilah Keene Kernville Lake Isabella Lamont Lancaster* Lebec Loraine Lost Hills Maricopa McFarland McKittrick MettlerMiracle Hot Springs Mojave Monolith Oildale Onyx Palmdale* Pine Mountain Pond PoseyRidgecrest* Rosamond Shafter Taft Tehachapi Tupman Twin OaksWalker Basin Wasco WeldonWheeler Ridge Wo ord Heights WoodySi necesita esta informaci n en espa ol.

2 Por favor ll *Medical services only. Not open for Kern Family Health Care NK*Servicios m dicos solamente. No esta abierto para inscribir en Kern Family Health NK1 Notice of Non-DiscriminationCall Member Services at 1-800-391-2000 (TTY/TDD 711).KFHC is here Monday through Friday, 8:00 am to 5:00 pm. The call is toll call the California Relay Line at 711. Visit online at Languages and FormatsOther languagesYou can get this Member Handbook and other plan materials for free in other languages. Call Member Services at (661) 632-1590 (Bakersfield) or 1-800-391-2000 (outside of Bakersfield) (TTY/TDD 711). The call is toll free. Read this Member Handbook to learn more about health care language assistance services, such as interpreter and translation services.

3 Other formatsYou can get this information for free in other formats, such as braille, 18-point font large print and audio. Call Member Services at (661) 632-1590 (Bakersfield) or1-800-391-2000 (outside of Bakersfield) (TTY/TDD 711). The call is toll servicesYou do not have to use a family member or friend as an interpreter. For free interpreter,linguistic and cultural services and help available 24 hours a day, 7 days a week, or to get this handbook in a different language, call Member Services at (661) 632-1590(Bakersfield) or 1-800-391-2000 (outside of Bakersfield) (TTY/TDD 711). The call is toll Languages and Formats2 Notice of Non-DiscriminationCall Member Services at 1-800-391-2000 (TTY/TDD 711).

4 KFHC is here Monday through Friday, 8:00 am to 5:00 pm. The call is toll call the California Relay Line at 711. Visit online at LANGUAGE ASSISTANCE TAGLINE English ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-800-391-2000 (TTY: 711). Espa ol (Spanish) ATENCI N: Si habla espa ol, tiene a su disposici n servicios gratuitos de asistencia ling stica. Llame al 1-800-391-2000 (TTY: 711). (Arabic) . : 1-2000-391-800 : )(711 . (Armenian) , : 1-800-391-2000 (TTY ( ) 711): (Cambodian) , 1-800-391-2000 (TTY:711) (Chinese) 1-800-391-2000 (TTY: 711) (Farsi).

5 1-800-391-2000 (TTY: 711) . (Hindi) : 1-800-391-2000 (TTY: 711) Hmoob (Hmong) LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-800-391-2000 (TTY: 711). (Japanese) 1-800-391-2000 (TTY: 711) (Korean) : , . 1-800-391-2000 (TTY: 711) . (Lao) : , , , . 1-800-391-2000 (TTY: 711). (Punjabi) : , 1-800-391-2000 (TTY: 711) ' Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

6 Звоните 1-800-391-2000 (телетайп: 711). Tagalog (Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-391-2000 (TTY: 711). (Thai) : 1-800-391-2000 (TTY: 711). Ti ng Vi t (Vietnamese) CH : N u b n n i Ti ng Vi t, c c c d ch v h tr ng n ng mi n ph d nh cho b n. G i s 1-800-391-2000 (TTY: 711). Other Languages and Formats3 Notice of Non-DiscriminationCall Member Services at 1-800-391-2000 (TTY/TDD 711).KFHC is here Monday through Friday, 8:00 am to 5:00 pm. The call is toll call the California Relay Line at 711. Visit online at of Non-DiscriminationDiscrimination is against the law.

7 Kern Family Health Care follows State and Federal civil rights laws. Kern Family Health Care 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. Kern Family Health Care 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 and other formats) Free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languagesIf you need these services, contact Member Services between 8:00 am and 5:00 pm, Monday through Friday by calling (661) 632-1590 (Bakersfield) or 1-800-391-2000 (outside of Bakersfield) (TTY/TDD 711).

8 Or, if you cannot hear or speak well, please call 711 to use the California Relay to file a grievanceIf you believe that Kern Family Health Care 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 a Member Services Representative. You can file a grievance in writing, in person, or electronically: By phone: Contact between 8:00 am and 5:00 pm, Monday through Friday by calling (661) 632-1590 (Bakersfield) or 1-800-391-2000 (outside of Bakersfield).

9 Or, if you cannot hear or speak well, please call (TTY/TDD 711) to use the California Relay Service . In writing: Fill out a complaint form or write a letter and send it to: Kern Family Health Care, Member Services Department 2900 Buck Owens Boulevard, Bakersfield, CA 93308-63164 Notice of Non-DiscriminationCall Member Services at 1-800-391-2000 (TTY/TDD 711).KFHC is here Monday through Friday, 8:00 am to 5:00 pm. The call is toll call the California Relay Line at 711. Visit online at In person: Visit your doctor s office or Kern Family Health Care and say you want to file a grievance. Electronically: Visit Kern Family Health Care s website at Office of civil rights California department of health care servicesYou 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 916-440-7370.

10 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 RightsDepartment of Health Care ServicesOffice of Civil Box 997413, MS 0009 Sacramento, CA 95899-7413 Complaint forms are available at Electronically: Send an email to Office of civil rights Department of health and human servicesIf 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 Department of Health and Human Services, Office for Civil Rights by phone, in writing or electronically: By phone: Call 1-800-368-1019.