處方藥共付額可能依據您所取得的額外協助級別而有差異請與計畫聯絡查詢詳情可能會有限制共付額和限制規定如需更多資訊, 請致電 Health Net Cal MediConnect 會員服務部或閱讀 Health Net Cal MediConnect 會員手冊福利和 ( 或 ) 共付額可能於每

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1 取得您所需服務的簡單方法! Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) Cal MediConnect 為符合 Medi-Cal 和 Medicare 兩種資格的民眾提供的健康福利和服務什麼是 Cal MediConnect? Medi-Cal 和 Medicare 共同合作提供 Cal MediConnect 本方案將您所有的 Medi-Cal 和 Medicare 福利全都整合到一個健保計畫中一個健保計畫管理您的照護事宜一個聯絡電話號碼一張會員卡 Cal MediConnect 計畫將您所有的 Medicare 和 Medi-Cal 福利整合, 還提供更多福利 : 年度眼睛檢查和眼鏡載送到醫療服務地點您的 Cal MediConnect 團隊 Cal MediConnect 計畫也有醫療保健服務提供者團隊, 同心協力為您提供護理包括 : 個人照護協調員 ( 例如護士 ) 醫師醫院專科醫師藥房行為健康讓您更容易取得所需的健康福利和服務有疑問? 長期服務和支援 (LTSS) 請致電 ( 聽障專線 :711), 週一至週五, 上午 8 時至下午 8 時提供服務非營業時間週末及假日, 您可以留言我們會在下一個工作日給您回電此專線為免付費電話您也可以到我們的網站取得更多資訊, 網址非處方 (OTC) 用品全球急診照護例行足科處方藥承保 24 小時護士諮詢專線居家和社區型服務行為健康照護長期和急性照護醫療器材和用品 H3237_18_LAFactSheet_CHI_Accepted

2 處方藥共付額可能依據您所取得的額外協助級別而有差異請與計畫聯絡查詢詳情可能會有限制共付額和限制規定如需更多資訊, 請致電 Health Net Cal MediConnect 會員服務部或閱讀 Health Net Cal MediConnect 會員手冊福利和 ( 或 ) 共付額可能於每年 1 月 1 日變更 Health Net Community Solutions, Inc. 是與 Medicare 和 Medi-Cal 簽約的醫療保健計畫公司, 為計畫參加者提供兩種方案的福利 Health Net Community Solutions, Inc. 是 Health Net, Inc. 的子公司 Health Net 是 Health Net, Inc. 的註冊服務標章保留所有權利 FLY017848CR00 (11/17)

3 Health Net Cal MediConnect Nondiscrimination Notice Health Net Community Solutions, Inc. (Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Health Net Cal MediConnect does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Health Net Cal MediConnect: Provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, 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 Health Net Cal MediConnect Customer Contact Center at (Los Angeles), (San Diego) (TTY: 711) from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can leave a message. Your call will be returned within the next business day. The call is free. If you believe that Health Net Cal MediConnect has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance by calling the number above and telling them you need help filing a grievance; the Health Net Cal MediConnect Customer Contact Center is available to help you. 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, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, , (TDD: ). Complaint forms are available at CMC Nondiscrimination Notice_LP FLY015186EO00 (8/17) CA_MMP_2017_NDN_

4 Multi-Language Insert Multi-language Interpreter Services English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call (Los Angeles), (San Diego) (TTY: 711). Spanish: ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (Los Angeles), (San Diego) (TTY: 711). Chinese Mandarin: 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務請致電 (Los Angeles), (San Diego) (TTY: 711) Chinese Cantonese: 注意 : 如果您說中文, 您可獲得免費的語言協助服務請致電 (Los Angeles), (San Diego)(TTY: 711) Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (Los Angeles), (San Diego) (TTY: 711). Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (Los Angeles), (San Diego) (TTY: 711). Korean: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (Los Angeles), (San Diego) (TTY: 711). 번으로전화해주십시오. Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (Los Angeles), (San Diego) (TTY: 711). ملحوظة: إذا كنت تتحدث العربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل بالرقم Arabic:.(TTY: 711) (San Diego) (Los Angeles) Hindi: ध य न द : यद आप ब लत ह त आपक ल ए म फत म भय षय सहय तय स वय ए उपलब ध ह (Los Angeles), (San Diego) (TTY: 711). पर क ल कर. Japanese: 注意事項 : 日本語を話される場合無料の言語支援をご利用いただけます (Los Angeles), (San Diego) (TTY: 711). までお電話にてご連絡ください توجه: اگر به زبان فارسی گفتگو می کنید تسهیالت زبانی بصورت رایگان برای شما فراهم می باشد. با Farsi:.(TTY: 711) (San Diego), (Los Angeles) Thai: เร ยน: ถ าค ณพ ดภาษาไทยค ณสามารถใช บร การช วยเหล อทางภาษาได ฟร โทร (Los Angeles), (San Diego) (TTY: 711). H3237_17_MLI_Accepted_

5 Armenian: ՈՒՇԱԴՐՈՒԹՅՈՒՆ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք (Los Angeles), (San Diego) (TTY: 711) Cambodian: ប រយ ត ន ប រ ស នជ អ នកន យ យ ភ ស ខ ម រ, ស វ ជ ន យផ ន កភ ស ដ យម នគ តឈ ន ល គ អ ចម នស រ រ រ បរ អ នក ច រ ទ រស ព ទ (Los Angeles), (San Diego) (TTY: 711). Hmong: LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau (Los Angeles), (San Diego) (TTY: 711). Punjabi: ਧ ਆਨ ਦ ਓ: ਜ ਤ ਸ ਪ ਜ ਬ ਬ ਲਦ ਹ, ਤ ਭ ਸ਼ ਵ ਚ ਸਹ ਇਤ ਸ ਵ ਤ ਹ ਡ ਲਈ ਮ ਫਤ ਉਪਲਬਧ ਹ (Los Angeles), (San Diego) (TTY: 711) ਤ ਕ ਲ ਕਰ Laotian: ໂປດຊາບ: ຖ າທ ານເວ າພາສາອ ງກ ດ, ການຊ ວຍເຫ ອດ ານພາສາທ ບ ເສຍຄ າມ ພ ອມໃຫ ທ ານ. ກະລ ນາໂທ (Los Angeles), (San Diego) (TTY: 711). Cal MediConnect Member Multi-Language Insert FLY015174ZO00 (8/17)

2018_CA_MMP_LA_OTCFLY_CHI

2018_CA_MMP_LA_OTCFLY_CHI 因為您是 Health Net Cal MediConnect Plan (Medicare-Medicaid Plan) 會員, 所以不需要額外付費就能透過郵購方式訂購特定的非處方 (OTC) 健康用品 OTC 產品可以治療輕症, 幫助您減少就診的次數並能為您省錢您可以訂購的 OTC 用品包括 : 止痛用品制酸劑通便劑咳嗽或感冒用品急救箱用品牙齒保健耳朵和眼睛保健維他命如需完整的產品清單,