Non-Discrimination & Language Access
Quartz is the brand name for a group of companies committed
to your health: Quartz Health Benefit Plans Corporation,
Quartz Health Insurance Corporation, Quartz Health Plan
Corporation, and Quartz Health Plan MN Corporation. These
companies are separate legal entities. In this notice, “we”
refers to all Quartz companies.
For assistance understanding these materials in a language
other than English, call (800) 362-3310, and a Customer
Service representative will assist you. TTY users should call
711 or (800) 877-8973.
We comply with applicable Federal civil rights laws and do
not discriminate on the basis of race, color, national origin,
age, disability, or sex.
We provide free aids and services to people with disabilities
to communicate eectively with us, such as –
■
Qualified sign language interpreters
■
Written information in other formats (large print, audio,
accessible electronic formats, other formats)
We provide free language services to people whose primary
language is not English, such as –
■
Qualified interpreter
■
Information written in other languages
If you need these services, contact Customer Service at
(800)362-3310.
If you believe we 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 –
Kristie Meier, Compliance Ocer
840 Carolina Street
Sauk City, WI 53583
Phone: (800) 362-3310
TTY: 711 or toll-free (800) 877-8973
Fax: (608) 644-3500
Email: AppealsSpecialists@quartzbenefits.com
You can file a grievance in person or by mail, fax or email. If
you need help filing a grievance, Kristie Meier, Compliance
Ocer, is available to help you. You can also file a civil
rights complaint with the U.S. Department of Health and
Human Services, Oce for Civil Rights, electronically
through the Oce for Civil Rights Complaint Portal,
available at 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, D.C. 20201
(800) 368-1019; (800) 537-7697 (TDD)
Complaint forms are available at hhs.gov/ocr/oce/file/
index.html
Quartz is a Qualified Health Plan issuer in the Health
Insurance Marketplace in certain states. To learn more, visit
the Health Insurance Marketplace at HealthCare.gov.
For help to translate or understand this, please call
(800) 362-3310, TTY: 711 / (800) 877-8973.
Spanish – Este Aviso contiene información importante. Este aviso
contiene información importante acerca de su solicitud o cobertura
a través de Quartz. Preste atención a las fechas clave que contiene
este aviso. Es posible que deba tomar alguna medida antes de
determinadas fechas para mantener su cobertura médica o ayuda
con los costos. Usted tiene derecho a recibir esta información
y ayuda en su idioma sin costo alguno. Llame al (800)362-3310.
TTY/TDD:711/(800)877-8973.
Hmong – Tsab ntawv tshaj xo no muaj cov ntshiab lus tseem ceeb.
Tsab ntawv tshaj xo no muaj cov ntsiab lus tseem ceeb txog koj daim
ntawv thov kev pab los yog koj qhov kev pab cuam los ntawm Quartz.
Saib cov caij nyoog los yog tej hnub tseem ceeb uas sau rau hauv daim
ntawv no kom zoo. Tej zaum koj kuj yuav tau ua qee yam uas peb kom
koj ua tsis pub dhau cov caij nyoog uas teev tseg rau hauv daim ntawv
no mas koj thiaj yuav tau txais kev pab cuam kho mob los yog kev pab
them tej nqi kho mob ntawd. Koj muaj cai kom lawv muab cov ntshiab
lus no uas tau muab sau ua koj hom lus pub dawb rau koj. Hu rau
(800)362-3310. TTY/TDD:711/(800)877-8973.
Vietnamese – Thông báo này cung cấp thông tin quan trọng. Thông
báo này có thông tin quan trọng bàn về đơn nộp hoặc hợp đồng
bảo hiểm qua chương trình Quartz. Xin xem ngày then chốt trong
thông báo này. Quý vị có thể phải thực hiện theo thông báo đúng
trong thời hạn để duy trì bảo hiểm sức khỏe hoặc được trợ trúp
thêm về chi phí. Quý vị có quyền được biết thông tin này và được trợ
giúp bằng ngôn ngữ của mình miễn phí. Xin gọi số (800)362-3310.
TTY/TDD:711/(800)877-8973.
Chinese – 本通知含有重要的訊息 本通知對於您透過 Quartz 所
提 出的申請或保險有重要的訊息 請在本通知中查看重要的日
期 您可能要在特定的截止日期之 前採取行動，以保留您的健
康保險或有助於省錢 您有權利免費以您的母語得到幫助和訊
息 請致電
(800)362-3310
：
711/(800)877-8973.
Russian – Настоящее уведомление содержит важную информацию.
Это уведомление содержит важную информацию о вашем
заявлении или страховом покрытии через Quartz. Посмотрите
на ключевые даты в настоящем уведомлении. Вам, возможно,
потребуется принять меры к определенным предельным срокам
для сохранения страхового покрытия или помощи с расходами.
Вы имеете право на бесплатное получение этой информации и
помощь на вашем языке. Звоните по телефону (800)362-3310.
TTY/TDD:711/(800)877-8973.
an
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Quartz.
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(800)
362 3310. TTY / TDD: 711 / (800) 877 8973
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