Notice of nondiscrimination & language assistance

[LEGAL ENTITY NAME, e.g. Bedrock TPA, LLC] complies with applicable federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, age, disability, or sex.

Free aids and services

We provide, free of charge:

• Aids and services to people with disabilities to help them communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats).
• 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, call 424-835-1391 or email info@bedrock-tpa.com. Interpreter services are provided by phone.

How to file a grievance

If you believe we have 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 with our Civil Rights Coordinator:

[CIVIL RIGHTS COORDINATOR NAME & TITLE]
[LEGAL ENTITY NAME, e.g. Bedrock TPA, LLC]
Phone: 424-835-1391
Email: info@bedrock-tpa.com

You can file a grievance by phone or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

File a civil rights complaint with the federal government

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 at ocrportal.hhs.gov, or by mail or phone at:

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

Complaint forms are available at hhs.gov/ocr.

Language assistance

• Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 424-835-1391.
• 繁體中文 (Chinese): 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 424-835-1391。
• Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 424-835-1391.
• Tagalog (Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 424-835-1391.
• 한국어 (Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 424-835-1391 번으로 전화해 주십시오.
• Հայերեն (Armenian): ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ։ Զանգահարեք 424-835-1391։
• Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 424-835-1391.
• فارسی (Farsi): توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با 424-835-1391 تماس بگیرید.
• 日本語 (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。424-835-1391 まで、お電話にてご連絡ください。
• العربية (Arabic): ملحوظة: إذا كنت تتحدث اللغة العربية، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 424-835-1391.
• ਪੰਜਾਬੀ (Punjabi): ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 424-835-1391 'ਤੇ ਕਾਲ ਕਰੋ।
• ភាសាខ្មែរ (Khmer): ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ 424-835-1391។
• Hmoob (Hmong): LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 424-835-1391.
• हिंदी (Hindi): ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 424-835-1391 पर कॉल करें।
• ไทย (Thai): เรียน: ถ้าคุณพูดภาษาไทย คุณสามารถใช้บริการช่วยเหลือทางภาษาได้ฟรี โทร 424-835-1391.

This notice is provided for informational purposes and is not legal advice. Before publication, confirm with counsel which languages must be included for your service area and verify each tagline against the current official translations published by HHS/CMS.