Your Health Matters - English

This booklet shares information about benefits, services, and resources available to you as an HPSJ member.

Thank you for being a Health Plan

We support our members by giving them the tools for a

We are proud to offer:

The goal of Health Plan of San Joaquin (HPSJ) is to improve the health of our community by creating health care value and advancing health care outcomes. HPSJ makes its members a priority, and will support you in any way we can.

If you need anything or have questions, do not hesitate to call 888.936.PLAN (7526), TTY 711. Visit us online at www.hpsj.com

Mental Health Services

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

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

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

• Help with focusing, attention, and memory

• Outpatient services for the purposes of monitoring medication therapy

• Labs and medications

• Psychiatric consultation

• Family Therapy

Depression screening is an important part of any care plan. Your PCP may ask you questions and make a referral if needed.

Health Plan of San Joaquin is proud to offer the Nationa Diabetes Prevention Program (DPP) online along with Melon Health. Contact the Health Education team by phone or email (209.942.6356, healtheducation@hpsj.com) to enroll. Members can opt in or out of this program at any time.

A message from your care team

Protecting Your Identity is Our Priority

Customer Service staff must check 3 pieces of Private Heath Info (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 HPSJ 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.

Dental services are one of 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 with fluoride varnish. Talk to your child’s pediatrician about fluoride varnish during any well visit.

We can help you get care!

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.

Need a ride?

Health Plan of San Joaquin provides non-medical transportation services for members:

1. Who do not have their own transportation available

2. For medically necessary managed care plan covered services

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

Health Plan of San Joaquin works with Carelon Behavioral Health* to provide behavioral health services.

✓ Get information

✓ Find a behavioral health doctor

✓ Make an appointment

Eye exams are a covered benefit for HPSJ 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 of San Joaquin (HPSJ) member, you have the right to no-cost interpretations. This includes American Sign Language. It is vital to use a skilled interpreter when you have an appointment. You should not use friends, family, or children to interpret for you.

An interpreter can help you:

• Translate medical terms to help you better understand your visit

• Make good choices about your health

• Take control of your health

• Understand how to take your medication

How to schedule

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

Do you need materials in your language or format?

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

Call HPSJ’s Customer Service Department at 888.936.7526, TTY 711 with your Alternate Format Request. Customer Service representatives are available to help Monday – Friday, 8 am to 5 pm.

For language services after hours and on the weekends, call the Advice Nurse at 800.655.8294, TTY 711.

*Previously known as Beacon Health Options

Choosing Your Doctor

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

*Continuity of Care (COC) gives members continued access to non-HPSJ 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 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 outof-network group)

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

• Podiatry services

• Eligible dental services

• Initial mental health assessment

Not sure which doctor you are assigned to? View your PCP online with a myHPSJ member portal account (visit www.hpsj.com/create-anaccount for more details) or call HPSJ’s Customer Service Department at 1.888.936.7526, TTY 711.

Your Primary Care Provider (PCP) is part of your health care team

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.

Here at HPSJ 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:

What does respect mean to us?

Health care is personal, and the decisions you make with your doctor are important. We need to trust each other. 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

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. And the things you talk about should be kept private.

Provide

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.

Urgent Care Emergency Room VS

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 usual doctor is not available. Not sure which one to use? We can help.

The ER is for emergency situations. Urgent care clinics can handle non-life-threatening issues. Urgent care clinics are not a replacement for the 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

• Fever

• Dehydration

• Ear pain

• Urinary tract infections and other infections

Not sure what to do? Call our advice nurse line at 1.800.655.8294. A nurse is available to you 24/7.

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

Know your health care options

• Seizures

• Severe cuts or burns

• Sudden dizziness or numbness

• Severe allergic reaction

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 an HPSJ member you can find a doctor or even an urgent care location near you here www.hpsj.com/find-a-doctor

Get rewarded for being healthy!

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

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

Well Child: 3-21Years Old - Well child visits between the ages of 3-21 at least once a year.

Immunizations for Toddlers - By age 2 children should have the following vaccines series: DTaP*, IPV*, measles, mumps, and rubella, HiB*, HepA, 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 - 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 from 1/1/23-12/31/23.

Need to quit tobacco?

HPSJ members can get free quit aids. Quit aids can be a big part in helping you quit nicotine. Talk to your doctor about what quit aids/meds can help you.

Cervical Cancer ScreeningWomen 21 or older.

Breast Cancer ScreeningWomen 50 or older: get your mammogram done to prevent or catch breast 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 - Visit doctor within the first three months (12 weeks) of becoming pregnant or within 42 days of becoming an HPSJ member.

Postpartum Visit - Women who gave birth should have at least one postpartum visit on or between 7 and 84 days after delivery.

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

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

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

Call Kick It California for free counseling services.

English Tagline

ATTENTION: If you need help in your language call 888.936.7526, TTY/TDD 711. Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 888.936.7526, TTY/TDD 711. These services are free of charge.

ដូចជាឯកសារសរបសរជាអ្កសរផុសសត្ា ់ជនព្ិការភ្ននក ឬឯកសារសរបសរជាអ្កសរព្ុមពធំ ក៏អាចរកបានផងភ្ដរ។ ទូរស័ព្ទមកបេខ 888.936.7526, TTY/TDD 711។ បសវាកមមទំងបនេះមិនគិរថ្លៃប

Nqe Lus Hmoob Cob (Hmong)

CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus hu rau

888.936.7526, TTY/TDD 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 888.936.7526, TTY/TDD 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 888.936.7526, TTY/TDD 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。 888.936.7526, TTY/TDD 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。 한국어

888.936.7526, TTY/TDD 711

888.936.7526, TTY/TDD 711

888.936.7526, TTY/TDD 711.

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 888.936.7526, TTY/TDD 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

888.936.7526, TTY/TDD 711. Naaiv deix nzie weih gong-bou jauvlouc se benx wang-henh tengx mv zuqc cuotv nyaanh oc.

888.936.7526, TTY/TDD 711.

Русский слоган (Russian)

родном

звоните по номеру 888.936.7256 (линия TTY/TDD711). Также предоставляются средства и услуги для людей с ограниченными возможностями, например документы крупным шрифтом или шрифтом Брайля. Звоните по номеру 888.936.7256 (линия

TTY/TDD 711). Такие услуги предоставляются бесплатно

Mensaje en español (Spanish)

ATENCIÓN: si necesita ayuda en su idioma, llame al 888.936.7526, TTY/TDD 711. También ofrecemos asistencia y servicios para personas con discapacidades, como documentos en braille y con letras grandes. Llame al 888.936.7526, TTY/TDD 711. Estos servicios son gratuitos.

Tagalog Tagline (Tagalog)

ATENSIYON: Kung kailangan mo ng tulong sa iyong wika, tumawag sa 888.936.7526, TTY/TDD 711. Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan,tulad ng mga dokumento sa braille at malaking print. Tumawag sa 888.936.7526, TTY/TDD 711. Libre ang mga serbisyong ito.

แท็กไลน์ภาษาไทย

ที่เป็นอักษรเบรลล์และเอกสารที่พิมพ์ด้วยตัวอักษรขนาดใหญ่ กรุณาโทรศพทไปทหมายเลข 888.936.7526, TTY/TDD 711 ไม่มคาใชจายสาหรบบรการเหลาน

Примітка українською (Ukrainian)

УВАГА! Якщо вам потрібна допомога вашою рідною мовою, телефонуйте на номер

888.936.7526, TTY/TDD 711. Люди з обмеженими можливостями також можуть скористатися допоміжними засобами та послугами, наприклад, отримати документи, надруковані шрифтом Брайля та великим шрифтом. Телефонуйте на номер

888.936.7526, TTY/TDD 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 888.936.7526, TTY/TDD 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 888.936.7526, TTY/TDD 711. Các dịch vụ này đều miễn phí.

Discrimination is against the law. Health Plan of San Joaquin 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 of San Joaquin 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 of San Joaquin between Monday-Friday 8:00 a.m. - 5:00 p.m. by calling 888.936.7526. If you cannot hear or speak well, please call TTY/TDD 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:

Health Plan of San Joaquin

7751 South Manthey Road, French Camp, CA 95231

888.936.PLAN (7526), TTY/TDD 711

HOW TO FILE A GRIEVANCE

If you believe that Health Plan of San Joaquin 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 of San Joaquin’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 888.936.7526. Or, if you cannot hear or speak well, please call TTY/TDD 711.

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

Health Plan of San Joaquin

Attn: Grievance and Appeals Department 7551 S. Manthey Road, French Camp, CA 95231 888.936.PLAN (7526), TTY/TDD 711

By fax: 209.942.6355

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

• Electronically: Visit Health Plan of San Joaquin's website at www.hpsj.com

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/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 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.

French Camp, CA 95231

888.936.PLAN (7526), TTY 711

www.hpsj.com