Your Health Matters 2024 - English

Your Health Matters

Use this as a helpful guide about health care access and your benefits.

The goal of Health Plan of San Joaquin/ Mountain Valley Health Plan (“Health Plan”) is to improve the health of our community by creating health care value and advancing health care outcomes. We are here to support you.

HealthReach | 800-655-8294

Need to ask a question about your health?

Call HealthReach, a FREE phone service for peace of mind when your doctor is not available. Nurses are available 24/7 to answer questions, give health advice, and help with medication prescriptions. Language assistance is also offered.

Transportation | 888-936-7526

Need a ride? Health Plan provides non-medical transportation services for members:

• Who do not have their own transportation available

• For medically necessary managed care plan covered services

Types of transportation: City bus vouchers, rideshare, taxi, mileage reimbursements

Behavioral Health | 888-581-7526

HPSJ works with Carelon Behavioral Health to provide behavioral health services.

• Get information

• Find a behavioral health doctor

• Make an appointment Eye Care | 888-321-7526 | www.vsp.com

Eye exams are a covered benefit for Health Plan members. Call VSP to see if you are eligible for your eye exam!

Language Services | 888-936-7526

Help in your language!

As a Health Plan member, you have the right to no-cost interpreting. This includes American Sign Language (ASL). It is vital to rely on a skilled interpreter when you have an appointment. You should not rely on friends, family, or children to interpret for you.

An interpreter can help you:

• Better understand your visit

• Share concerns

• Take control of your health

• Understand how to take your medication

How to schedule:

Call Customer Service at least 5 days before your visit (10 days for ASL). We want to schedule the best person to help you.

Do You Need Materials in Your Language or Format?

Health Plan can help with translation or information in an alternate format. That includes written Braille, audio CD, large print, and electronic format for easy reading.

Call Customer Service at 1-888-936-7526 TTY 711 with your Alternate Format Request. Customer Service representatives are available to help Monday-Friday, 8:00 am-5:00 pm.

For language services after hours and on the weekends, call the Advice Nurse at 1-800-655-8294 TTY 711.

Choosing Your Doctor

When joining Health Plan, picking a doctor is one of the first things you should do. If you see a doctor that is not in Health Plan’s network, you may be able to keep them for 12 months in certain cases. If your doctor does not join Health Plan’s network by the end of 12 months, you will need to change to an Health Plan doctor. To learn how you can continue to see your doctor, visit www.hpsj.com/continuity-of-care.*

*Continuity of Care (COC) gives members continued access to nonHealth Plan doctors for either medical or behavioral health services. When you go to the same group or doctors or clinics, your health history from the clinic or group is available at your next visit. Even if you don’t see the same doctor every time, they are still part of your care team.

Need To See a Specialty Doctor?

Your Primary Care Provider (PCP) will give you a referral to send you to a specialist if you need one. A specialist is a doctor who has extra education in one area of medicine. Your doctor will work with you to choose a specialist and help you set up an appointment.

The best way to make sure your voice is heard is to tell your doctor what your needs are.

You Do Not Need a Referral For:

• Regular doctor visits

• Obstetrics/Gynecology (OB/GYN) visits

• Urgent or emergency care visits

• Adult sensitive services, such as sexual assault care

• Family planning services (learn more by calling the Office of Family Planning Information and Referral Service at 1-800-942-1054)

• HIV testing and counseling (12 years or older)

• Sexually transmitted infection services (12 years or older)

• Chiropractic services (a referral may be required when provided by out-of-network group)

• Acupuncture (the first two services per month; additional appointments will need a referral)

• Podiatry services

• Eligible dental services

• Initial mental health assessment

Your Primary Care Provider (PCP) Is Part of Your Health Care Team

At Health Plan, we understand that good health care starts with respect. You have the right to be treated with respect when you see your doctor. Among other things, the care you get should respect your:

• Race

• Culture

• Language • Religion

• Age

• Gender

• Disability

• Sexual Identity Orientation

What Does Respect Mean to Us?

Yearly Check-Ins

You should see your PCP every year to check in on your health. This might include screenings, labs, and a physical. All of these together help build a care plan that is right for you.

Health care is personal, and the decisions you make with your doctor are important. You and your doctor can build a trusting relationship. To help build that trust, your doctor and their staff should:

Give You Information

They should help you understand your condition and your treatment options so that you can decide what to do. You should be able to get that info in the language or way you prefer.

Include You in Decisions

Your care plan should be based on your needs and choices. No two patients are the same.

Do Not Stay Silent

Treat You With Dignity

You should feel safe and respected by your doctors and their office staff. The things you talk about should be kept private.

Provide Easy Access to Their Services

This is very important if you have a disability or other special needs.

You have a responsibility to provide information that helps your doctor provide the right care. It is important to follow care plans and care instructions that you agree with. If you feel you are not being treated with respect, let us know. If you are not happy with your provider, you have the right to change providers by calling us.

Get rewarded for being healthy!

Well Visit: 0-15 Months – Your baby must have six well child exams by the time they are 15 months old.

Well Visit: 15-30 Months – At least two visits between 15-30 months.

Well Visit: 3-20 Years Old – At least one visit per year between the ages of 3-20.

Well Visit: 20+ Years Old – Adults 20 and over should see their PCP once a year for a preventative health visit. This visit may cover the ABC’s of health: A1c check, blood pressure check, and cholesterol or cancer screenings.

Immunizations for Toddlers – By age 2, children should have the following vaccines series: DTaP, IPV, measles, mumps, and rubella, HiB, Hep A, Hep B, chicken pox, PCV, rotavirus, and flu.

*DTaP= diphtheria, tetanus, and acellular pertussis; IPV = polio, HiB= haemophilus influenza type B; HepA= hepatitis A; HepB= hepatitis B; PCV = pneumococcal conjugate

Immunizations for Teens – Children should have the following vaccines before their 13th birthday: 1 dose meningococcal, 1 dose Tdap, complete HPV services (2 doses).

Flu Shot – Anyone 6 months or older: Make an appointment with your doctor or visit a local pharmacy or clinic to get your annual flu shot.

Cervical Cancer Screening – Women 21-64 years need a cervical cancer screening every 3 years. Women 30-64 years need a cervical cancer screening with HPV testing every 5 years.

Breast/Chest Cancer Screening – Anyone 5-74 years old. Call or go to your Doctor to ask for a mammogram every two years. Get your mammogram done to prevent or catch breast/ chest cancer early.

You can get rewards for you and your family after going to the doctor for certain health exams. You may get a $25 gift card if you qualify.

Prenatal & Immunizations –Visit doctor within the first three months (12 weeks) of becoming pregnant or withing 42 days of becoming an Health Plan member. Pregnant woman should receive influenza and Tdap vaccinations during their pregnancy to protect mom and baby.

Postpartum Visit & Depression Screening – Women who gave birth should have at least one postpartum visit on or between 7 and 84 days after delivery. All postpartum women should receive a depression screening after delivery, and follow-up care if needed.

Lead Screening – At least 2 lead screenings for children under 2 or 1 catch-up lead screening before age 6.

Colorectal Screening – Adults ages 45-75 should get screened for colorectal cancer with any of the following tests: annual fecal occult blood test; flexible sigmoidoscopy every 5 years; colonoscopy every 10 years; computed tomography colonography every 5 years; stool DNA test every 3 years.

Diabetes A1C Exam – Adults ages 18-75 with diabetes (type 1 or type 2): get an A1C blood test screening.

Other rewards may be available. Visit www.hpsj.com/myrewards to learn more!

Join the Diabetes Prevention Program

Health Plan has partnered with Inspiring Communities to offer a Diabetes Prevention Program (DPP).

To enroll, contact the Health Education team at 209-942-6356 or healtheducation@hpsj.com.

Members can opt in or out at any time.

Learn more about the program online at www.hpsj.com/dpp.

Life does not start and stop between 8 am and 5 pm.

Sometimes you get sick when your doctor has gone home for the day. Both the emergency room (ER) — sometimes called the emergency department (ED) — and urgent care clinics can help you when your doctor is not available.

Not sure which one to use? We can help. The emergency room is for emergency situations. Urgent care can handle non-life-threatening issues. Urgent care is not a replacement for ER.

Most urgent care clinics can help you with minor injuries or minor asthma attacks. Here are some other common issues urgent care clinics can address:

• Minor cuts, even ones that need stitches

• Cold and flu symptoms

• Sprains and strains

• Nausea

• Minor burns

Not Sure What To Do?

• Fever

• Dehydration

• Ear pain

• Urinary tract infections and other infections

If you or someone you know is experiencing a medical emergency, you must go to the ER. They may need surgery or advanced treatment. Here are some, but not all, the issues that need ER care:

• Broken bones

• Chest pain or difficulty breathing

• Drug overdoses

• Changes in mental state

• Head injury

• Seizures

• Severe cuts or burns

• Sudden dizziness or numbness

• Severe allergic reaction

Know Your Health Care Options

Are you dealing with an emergency that needs attention like severe chest pain? Or is it a mild injury or illness? Any issue noted on page 10 can be handled at urgent care. Urgent care and ER options cannot replace your regular doctor. Having regular doctor visits is important for prevention and managing health issues you already have.

Don’t Have a Go-To

Doctor?

As a Health Plan member, you can find a doctor or even an urgent care location near you at www.hpsj.com/find-a-doctor.

Mental Health Services

You may get a mental health assessment at any time from a licensed mental health provider in the Health Plan network without a referral. Health Plan covers mental health services such as:

• Individual, family, and group mental health evaluation and treatment (psychotherapy)

• Psychological testing when clinically indicated to evaluate a mental health condition

• Outpatient services for the purposes of monitoring medication therapy

• Labs and medications

• Psychiatric consultation

It is best practice for health care providers to conduct screenings. Your PCP might complete different screenings, including a depression screening. They should discuss the results with you and offer you a referral if needed.

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Dental Services

Dental services are one of the many programs covered when you qualify for Medi-Cal. Some members can get dental services provided through Medi-Cal Dental (previously known as Denti-Cal). You can protect those smiles. Talk to your child’s pediatrician about fluoride varnish during any visit.

Customer Service staff must check three pieces of Protected Health Information (PHI) before they can help members.

Callers 18 years of age or older need to call for themselves. If a parent or someone helping calls for a member, the member MUST give consent. To protect you and your information, you MUST first say it is okay for us to speak to the person calling.

*Your password must be at least 8 characters. You must have at least three of the following: • A capital letter

• A lower case letter • A symbol (example: #, $, @) • A number

If the box turns red, you need to correct the information before an account can be created. Read the notes under the red box to find out what information must be corrected.

LANGUAGE ASSISTANCE

English Tagline

ATTENTION: If you need help in your language call 1-888-936-7526, TTY 711. Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 1-888-936-7526, TTY 711. These services are free of charge.

ծառայություններն

ឃ្លាសម្គាល់ជាភាសាខ្មែរ (Cambodian)

ចំណំ៖

888-936-7526, TTY 711

ដចជាឯកសារសរបសរជាអ្កសរផសសត្ា

ឬឯកសារសរបសរជាអ្កសរព្ុមពធំ ក៏អាចរកបានផងភ្ដរ។ ទូរស័ព្ទមកបេខ 1-888-936-7526, TTY 711។ បសវាកមមទំងបនេះមិនគិរថ្លៃប ើយ។

简体中文标语 (Simplified Chinese)

请注意：如果您需要以您的母语提供帮助，请致电 1-888-936-7526 (TTY: 711)。我们另外还提供针对残疾人士的帮助和服务

Nqe Lus Hmoob Cob (Hmong)

CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus hu rau 1888-936-7526, TTY 711. Muaj cov kev pab txhawb thiab kev pab cuam rau cov neeg xiam oob qhab, xws li puav leej muaj ua cov ntawv su thiab luam tawm ua tus ntawv loj. Hu rau 1-888-936-7526, TTY 711. Cov kev pab cuam no yog pab dawb xwb.

日本語表記 (Japanese)

注意日本語での対応が必要な場合は 1-888-936-7526, TTY 711へお電 話ください。点字の資料や文字の拡大表示など、障がいをお持ちの 方のためのサービスも用意しています。 1-888-936-7526, TTY 711へ お電話ください。これらのサービスは無料で提供しています。

한 한국어 태 태그라인 (Korean)

유의사항: 귀하의 언어로 도움을 받고 싶으시면

1-888-936-7526, TTY 711 번으로 문의하십시오. 점자나 큰 활자로 된 문서와 같이 장애가 있는 분들을 위한 도움과 서비스도 이용

1-888-936-7526,

Mien Tagline (Mien)

LONGC HNYOUV JANGX LONGX OC: Beiv taux meih qiemx longc mienh tengx faan benx meih nyei waac nor douc waac daaih lorx taux 1-888-936-7526, TTY 711. Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh, beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh sou se mbenc nzoih bun longc. Douc waac daaih lorx 1-888-936-7526, TTY 711. Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv nyaanh oc.

(Punjabi)

1-888-936-7526, TTY 711

звоните по номеру 1-888-936-7526 (линия TTY 711). Также предоставляются средства

возможностями, например

шрифтом Брайля. Звоните по номеру 1-888-936-7526 (линия TTY 711). Такие услуги предоставляются бесплатно.

Mensaje en español (Spanish)

ATENCIÓN: si necesita ayuda en su idioma, llame al 1-888-936-7526, TTY 711. También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes. Llame al 1-888-936-7526, TTY 711. Estos servicios son gratuitos.

Tagalog Tagline (Tagalog)

ATENSIYON: Kung kailangan mo ng tulong sa iyong wika, tumawag sa 1-888-936-7526, TTY 711. Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan,tulad ng mga dokumento sa braille at malaking print. Tumawag sa 1-888-936-7526, TTY 711. Libre ang mga serbisyong ito.

(Thai)

:

Примітка українською (Ukrainian)

УВАГА! Якщо вам потрібна допомога вашою рідною мовою, телефонуйте на номер 1-888-936-7526, TTY 711. Люди з

обмеженими можливостями також можуть скористатися

допоміжними засобами та послугами, наприклад, отримати

документи, надруковані шрифтом Брайля та великим шрифтом.

Телефонуйте на номер 1-888-936-7526, TTY 711. Ці послуги безкоштовні.

Khẩu hiệu tiếng Việt (Vietnamese)

CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-888-936-7526, TTY 711. Chúng tôi cũng hỗ trợ và cung cấp các

dịch vụ dành cho người khuyết tật, như tài liệu bằng chữ nổi Braille và chữ khổ lớn (chữ hoa). Vui lòng gọi số 1-888-936-7526, TTY 711.

Các dịch vụ này đều miễn phí.

Nondiscrimination Notice

Discrimination is against the law. Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) follows State and Federal civil rights laws. Health Plan of San Joaquin 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.

Health Plan 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 languages

If you need these services, contact Health Plan between MondayFriday 8:00 a.m. - 5:00 p.m. by calling 1-888-936-7526. If you cannot hear or speak well, please call TTY 711 to use the California Relay Service. Upon request, this document can be made available to you in braille, large print, audio, and accessible electronic format. To obtain a copy in one of these alternative formats, please call or write to:

HOW TO FILE A GRIEVANCE

If you believe that Health Plan 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 Health Plan’s Civil Rights Coordinator, the Chief Compliance Officer. You can file a grievance in writing, in person, or electronically:

• By phone: Contact between Monday - Friday, 8:00 a.m.

- 5:00 p.m. by calling 1-888-936-7526. Or, if you cannot hear or speak well, please call TTY 711.

• In writing: Fill out a complaint form or write a letter and send it to:

Health Plan of San Joaquin/Mountain Valley Health Plan

Attn: Grievance and Appeals Department 7751 S. Manthey Road, French Camp, CA 95231 1-888-936-PLAN (7526), TTY 711 By fax: 209-942-6355

• In person: Visit your doctor's office or Health Plan and say you want to file a grievance.

• Electronically: Visit Health Plan's website at www.hpsjmvhp.org

If you need help filing a grievance, a Customer Service Representative can help you.

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 916-440-7370. 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 Rights Department of Health Care Services Office of Civil Rights P.O. Box 997413, MS 0009 Sacramento, CA 95899-7413

Complaint forms are available at www.dhcs.ca.gov/Pages/Language_Access.aspx

• Electronically: Send an email to CivilRights@dhcs.ca.gov

OFFICE OF CIVIL RIGHTS - U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

If you believe you have been discriminated against on the bases of race, color, national origin, age, disability or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights by phone, in writing, by phone or electronically:

• By phone: Call 1-800-368-1019. If you cannot speak or hear well, please call TTY 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 www.hhs.gov/ocr/office/file/index.html

• Electronically: Visit the Office for Civil Rights Complaint Portal at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.