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Kaiser Foundation Health Plan of Georgia, Inc.
60900708 08/2018
NON-DISCRIMINATION
Kaiser Foundation Health Plan of Georgia, Inc. (Health Plan) and Kaiser Permanente Insurance Company,
Inc. (KPIC), individually and collectively, comply with applicable Federal civil rights laws and do not
discriminate on the basis of race, color, national origin, age, disability, or sex. Neither Health Plan nor
KPIC exclude people or treat them differently because of race, color, national origin, age, disability, or
sex. Health Plan and KPIC, as applicable, also:
• Provide no cost aids and services to people with disabilities to communicate effectively with them, such as:
• Qualified sign language interpreters
• Written information in other formats, such as large print, audio, and accessible electronic formats
• Provide no cost language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If You need these services, call 1-888-865-5813 (TTY: 711)
If You believe that either Health Plan or KPIC 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
mail at: Member Relations Unit (MRU), Attn: Kaiser Civil Rights Coordinator, Nine Piedmont Center,
3495 Piedmont Road, NE Atlanta, GA 30305-1736. Telephone Number: 1-888-865-5813.
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
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, 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,
1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
Non-Discrimination
Kaiser Foundation Health Plan of Georgia, Inc. (Health Plan) and Kaiser Permanente Insurance Company, Inc. (KPIC), individually
and collectively, comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin,
age, disability, or sex. Neither Health Plan nor KPIC exclude people or treat them differently because of race, color, national origin,
age, disability, or sex. Health Plan and KPIC, as applicable, also:
• Provide no cost aids and services to people with disabilities to communicate effectively with them, such as:
• Qualified sign language interpreters
• Written information in other formats, such as large print, audio, and accessible electronic formats
• Provide no cost language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If You need these services, call 1-888-865-5813 (TTY: 711)
If You believe that either Health Plan or KPIC 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 mail at: Member Relations Unit (MRU), Attn: Kaiser
Civil Rights Coordinator, Nine Piedmont Center, 3495 Piedmont Road, NE Atlanta, GA 30305-1736. Telephone Number: 1-888-865-
5813.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electroni-
cally through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf,
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, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.html.
Help in Your Language
ATTENTION: If You speak English, language assistance services, free of charge, are available to You. Call 1-888-865-5813 (TTY:
711).
አ
ማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል ወደ ሚከተለው ቁጥር ይደውሉ 1-888-
865-5813 (TTY: 711).
(Arabic) TTY1-888-865-5813
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1-888-865-5813(TTY:711)。
(Farsi) 5813 (711 :TTY) 1-888-865-
Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le
1-888-865-5813 (TTY: 711).
Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur
Verfügung.
Rufnummer: 1-888-865-5813 (TTY: 711).
ગજ
ુ
રાતી (Gujarati) સ
ુ
ચના:
, :
. 1-888-865-
5813 (TTY: 711).
Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-
888-865-5813 (TTY: 711).
हिदी (Hindi) यान द: यदि आप द
िी बोलते तो आ प के दलए म
ु
त म भाषा स ायता सेवाए
उपलध । 1-888-865-5813 (TTY: 711) पर कॉल कर।