Blue Shield of California, an independent member of the Blue Shield Association C19927-FF (4/21)
Refusal of Coverage form
Complete this form if you, your spouse, domestic partner, or child dependent(s) are refusing this group health, dental, vision, and/or life insurance coverage offered through the
employer. (The employer must retain a copy of this form to provide to Blue Shield upon request.) Please type or print. Use black ink. *Note: The employee’s Social Security number
is required for all eligible employees.
Employee name Social Security number Date of birth
Employer (Group) name Hire date State of residence
Marital status Married Yes No
Domestic partnership Yes No
Job title
Is the employee a full-time employee, working at least 30 hours per week for this employer? Yes No Or
Is the employee a part-time employee, working at least 20 hours per week for this employer? Yes No
Declining coverage for:
I decline health plan coverage for:
Myself and all dependents.
My spouse/domestic partner only
My children only
My spouse/domestic partner and children only
The following dependents only:
________________________________________
If dental plan offered, I decline dental plan coverage for:
Myself and all dependents.
My spouse/domestic partner
My children
My spouse/domestic partner and children
The following dependents only:
________________________________________
If vision plan offered, I decline vision plan coverage for:
Myself and all dependents
My spouse/domestic partner
My children
My spouse/domestic partner and children
The following dependents only:
________________________________________
If life insurance plan offered, I decline life plan coverage for:
Myself
Reason employee is declining health coverage
OTHER EMPLOYER HEALTH COVERAGE
Enrolling as a dependent or an employee on this group health plan
Covered by this employer’s other health plan (through another carrier)
Covered by another employers health plan, including COBRA or Cal-COBRA coverage, through your spouse/domestic
partner, parent, or previous employer
OTHER NON-EMPLOYER HEALTH COVERAGE
Covered by an individual/family health plan
Covered by Government program, including Medicare, Medi-Cal, Healthy Families Program, TRICARE, Indian Health
Service, Tribal and Urban Indian Health Program, and Veterans Health Administration (VA)
OTHER REASONS
Reason employee is declining dental coverage
OTHER DENTAL COVERAGE
Enrolling as a dependent or an employee on this group dental plan
Covered by another employers dental plan, including COBRA or Cal-COBRA dental coverage, through your spouse/
domestic partner, parent, or previous employer
Covered by an individual/family dental plan
OTHER REASONS
Reason employee is declining vision coverage
OTHER VISION COVERAGE
Enrolling as a dependent or an employee on this group vision plan
Covered by another employers vision plan, including COBRA or Cal-COBRA vision coverage, through your spouse/
domestic partner, parent, or previous employer
Covered by an individual/family vision plan
OTHER REASO
NS
Reason employee is declining life insurance coverage
OTHER LIFE INSURANCE COVERAGE
Covered by another employer’s life insurance coverage through your spouse/domestic partner, or parent
OTHER REASONS
Cost of coverage
Do not need or do not want coverage
I acknowledge that the coverage available to me has been explained to me by my employer and I know that I have every right to enroll in this coverage and I have decided not to enroll
myself and/or my dependent(s), if any. I now decline to enroll myself, my spouse/domestic partner, and/or my child dependent(s) in my employer’s group health plan. I have made this
If I am declining enrollment for myself or my dependents because of other health coverage or because the employer stops contributing toward this coverage, I acknowledge that I may
be able to enroll myself and my dependents in this plan if I request enrollment within 60 days after my or my dependents’ other coverage ends or after the employer stops contributing
toward the other coverage.
In addition, if I acquire a new dependent as the result of marriage/domestic partnership, birth, adoption or placement for adoption, I acknowledge that I, and my dependents, may request
enrollment in my employer’s health plan by applying for that coverage within 60 days of the marriage/domestic partnership, birth, adoption, or placement for adoption. I also acknowledge
that if I, or my dependents, become eligible for the Healthy Families or the Medi-Cal Premium Assistance programs, I or my dependents may request enrollment in my employer’s health plan
by applying for coverage within 60 days of the notice of eligibility for these premium assistance programs.
within 60 days. Otherwise, I understand I may not enroll myself and/or my dependents in my employer’s health plan until the earlier of the end of my employer’s next open enrollment
period or 12 months.
Signature of employee Date
Blue Shield of California
Notice Informing Individuals about Nondiscrimination
and Accessibility Requirements
Discrimination is against the law
Blue Shield of California complies with applicable state laws and federal civil rights laws, and does
not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status,
gender, gender identity, sexual orientation, age, or disability. Blue Shield of California does not
exclude people or treat them differently because of race, color, national origin, ancestry, religion,
sex, marital status, gender, gender identity, sexual orientation, age, or disability.
Blue Shield of California:
Provides aids and services at no cost to people with disabilities to communicate effectively
with us such as:
- Qualified sign language interpreters
- Written information in other formats (including large print, audio, accessible electronic
formats, and other formats)
Provides language services at no cost to people whose primary language is not English such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact the Blue Shield of California Civil Rights Coordinator.
If you believe that Blue Shield of California has failed to provide these services or discriminated
in another way on the basis of race, color, national origin, ancestry, religion, sex, marital status,
gender, gender identity, sexual orientation, age, or disability, you can file a grievance with:
Blue Shield of California
Civil Rights Coordinator
P.O. Box 629007
El Dorado Hills, CA 95762-9007
Phone: (844) 831-4133 (TTY: 711)
Fax: (844) 696-6070
Email: BlueShieldCivilRightsCoordinator@blueshieldca.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our
Civil Rights Coordinator is available to help you. 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
(800) 368-1019; TTY: (800) 537-7697
Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.
Blue Shield of California
601 12
th
Street, Oakland CA 94607
Blue Shield of California is an independent member of the Blue Shield Association
A20275 (12/19)
blueshieldca.com
Notice of the Availability of Language Assistance Services
Blue Shield of California
IMPORTANT: Can you read this letter? If not, we can have somebody help you read it.
You may also be able to get this letter written in your language. For help at no cost, please
call right away at the Member/Customer Service telephone number on the back of your
Blue Shield ID card, or (866) 346-7198.
IMPORTANTE: ¿Puede leer esta carta? Si no, podemos hacer que alguien le ayude a leerla.
También puede recibir esta carta en su idioma. Para ayuda sin cargo, por favor llame
inmediatamente al teléfono de Servicios al miembro/cliente que se encuentra al reverso de
su tarjeta de identificación de Blue Shield o al (866) 346-7198. (Spanish)
重要通知:您能讀懂這封信嗎?如果不能,我們可以請人幫您閱讀。這封信也可以 用您所講的語言書寫
如需免费幫助,請立即撥打登列在您的Blue Shield ID卡背面上的 會員/客戶服務部的電話,或者撥打
電話 (866) 346-7198(Chinese)
QUAN TRNG: Quý v có th đọc lá thư này không? Nếu không, chúng tôi có th nh ngưi giúp quý
v đọc thư. Quý v cũng có th nhn lá thư này đưc viết bng ngôn ng ca quý v. Đ đưc h tr
min phí, vui lòng gi ngay đến Ban Dch v Hi viên/Khách hàng theo s mt sau th ID Blue Shield
ca quý v hoc theo s (866) 346-7198. (Vietnamese)
MAHALAGA: Nababasa mo ba ang sulat na ito? Kung hindi, maari kaming kumuha ng
isang tao upang matulungan ka upang mabasa ito. Maari ka ring makakuha ng sulat na
ito na nakasulat sa iyong wika. Para sa libreng tulong, mangyaring tumawag kaagad sa
numerong telepono ng Miyembro/Customer Service sa likod ng iyong Blue Shield ID kard,
o (866) 346-7198. (Tagalog)
Baa’ ákohwiindzindoo7g7: D77 naaltsoos7sh y77niłta’go b77n7ghah? Doo b77n7ghahgóó é7, naaltsoos nich’8’
yiid0o[tah7g77 ła’ nihee hól=. D77 naaltsoos a[d0’ t’11 Din4 k’ehj7 1dooln77[ n7n7zingo b7ighah. Doo b22h 7l7n7g0
sh7k1’ adoowo[ n7n7zing0 nihich’8’ b44sh bee hod7ilnih d00 n1mboo 47 d77 Blue Shield bee n47ho’d7lzin7g7
bine’d44’ bik11’ 47 doodag0 47 (866) 346-7198 j8’ hod77lnih. (Navajo)
중요: 서신을 읽을 있으세요? 읽으실 경우, 도움을 드릴 있는 사람이 있습니다. 또한 다른
언어로 작성된 서신을 받으실 수도 있습니다. 무료로 도움을 받으시려면 Blue Shield ID 카드 뒷면의
회원/고객 서비스 전화번호 또는 (866) 346-7198 지금 전환하세요. (Korean)
Կ
ԿԱԱՐՐԵԵՎՎՈՈՐՐ ԷԷ Կարողանում ե՞ք կարդալ այս նամակը։ Եթե ոչ, ապա մենք կօգնենք ձեզ։ Դուք պետք է
նաև կարողանաք ստանալ այս նամակը ձեր լեզվով։ Ծառայությունն անվճար է։ Խնդրում ենք
անմիջապես զանգահարել Հաճախորդների սպասարկման բաժնի հեռախոսահամարով, որը նշված է
ձեր Blue Shield ID քարտի ետևի մասում, կամ (866) 346-7198 համարով։ (Armenian)
ВАЖНО:
Не можете прочесть данное письмо? Мы поможем вам, если необходимо. Вы также можете
получить это письмо написанное на вашем родном языке. Позвоните в Службу клиентской/членской
поддержки прямо сейчас по телефону, указанному сзади идентификационной карты Blue Shield, или
по телефону (866) 346-7198, и вам помогут совершенно бесплатно. (Russian)
お客様は、この手紙を読むことができますか? し読むことができない場合、弊社が、お客様
をサポートする人物を手配いたします。 また、お客様の母国語で書かれた手紙をお送りすることも可
能です。 無料のサポートを希望される場合は、Blue Shield IDカードの裏面に記載されている会員/お客
様サービスの電話番号、または(866) 346-7198にお電話をおかけください。 (Japanese)
blueshieldca.com
:ﻢﮭﻣ ﯽﻣ ﺎﯾآﯽﻣ ،ﺖﺳا ﯽﻔﻨﻣ نﺎﺘﺨﺳﺎﭘ ﺮﮔا ؟ﺪﯿﻧاﻮﺨﺑ ار ﮫﻣﺎﻧ ﻦﯾا ﺪﯿﻧاﻮﺗﯽﻣ ﯽﺘﺣ .ﻢﯿھد راﺮﻗ نﺎﺗرﺎﯿﺘﺧا رد ﺎﻤﺷ ﮫﺑ ﮏﻤﮐ یاﺮﺑ ار ﯽﺴﮐ ﻢﯿﻧاﻮﺗ ﮫﺨﺴﻧ ﺪﯿﻧاﻮﺗ
زا ﺖﻗو تﻮﻓ نوﺪﺑ
ً
ﺎﻔﻄﻟ ،نﺎﮕﯾار ﮏﻤﮐ ﺖﻓﺎﯾرد یاﺮﺑ .ﺪﯿﻨﮐ ﺖﻓﺎﯾرد نﺎﺗدﻮﺧ نﺎﺑز ﮫﺑ ار ﮫﻣﺎﻧ ﻦﯾا بﻮﺘﮑﻣ ﯽﺳﺎﻨﺷ ترﺎﮐ ﺖﺸﭘ رد ﮫﮐ ﯽﻨﻔﻠﺗ هرﺎﻤﺷ ﻖﯾﺮط
Blue Shield ﻦﻔﻠﺗ هرﺎﻤﺷ ﻖﯾﺮط زا ﺎﯾ و ﺖﺳا هﺪﺷ جرد نﺎﺗ7198-346 )866.ﺪﯾﺮﯿﮕﺑ سﺎﻤﺗ یﺮﺘﺸﻣ/ﺎﻀﻋا تﺎﻣﺪﺧ ﺎﺑ ( (Persian)
:        ?               
                     
Blue Shield ID     /    ,  (866) 346-7198    (Punjabi)
 ?   
  
 /   Blue Shield
  (866) 346-7198 (Khmer)
: ﻢﮭﻤﻟا اﺬھ ﻰﻠﻋ لﻮﺼﺤﻟا ﻰﻟإ
ً
ﺎﻀﯾأ جﺎﺘﺤﺗ ﺪﻗ .ﮫﺗءاﺮﻗ ﻲﻓ كﺪﻋﺎﺴﯿﻟ ﺎﻣ ﺺﺨﺷ رﺎﻀﺣإ ﺎﻨﻨﻜﻤﯾ ،ﮫﺗءاﺮﻗ ﻊﻄﺘﺴﺗ ﻢﻟ نأ ؟بﺎﻄﺨﻟا اﺬھ ةءاﺮﻗ ﻊﯿﻄﺘﺴﺗ ﻞھ
ﺎﺠﻟا ﻰﻠﻋ نوﺪﻤﻟا ءﺎﻀﻋﻷا ﺪﺣأ/ءﻼﻤﻌﻟا ﺔﻣﺪﺧ ﻒﺗﺎھ ﻢﻗر ﻰﻠﻋ نﻵا لﺎﺼﺗﻻا ﻰﺟﺮﯾ ،ﺔﻔﻠﻜﺗ نوﺪﺑ ةﺪﻋﺎﺴﻤﻟا ﻰﻠﻋ لﻮﺼﺤﻠﻟ .ﻚﺘﻐﻠﺑ
ً
ﺎﺑﻮﺘﻜﻣ بﺎﻄﺨﻟا ﻲﻔﻠﺨﻟا ﺐﻧ
ﺔﯾﻮﮭﻟا ﺔﻗﺎﻄﺑ ﻦﻣBlue Shield ﻢﻗﺮﻟا ﻰﻠﻋ وأ7198-346 )866.((Arabic)
TSEEM CEEB: Koj pos tuaj yeem nyeem tau tsab ntawv no? Yog hais tias nyeem tsis tau, peb tuaj yeem nrhiav ib tug
neeg los pab nyeem nws rau koj. Tej zaum koj kuj yuav tau txais muab tsab ntawv no sau ua koj hom lus. Rau kev pab
txhais dawb, thov hu kiag rau tus xov tooj Kev Pab Cuam Tub Koom Xeeb/Tub Lag Luam uas nyob rau sab nraum nrob
qaum ntawm koj daim npav Blue Shield ID, los yog hu rau tus xov tooj (866) 346-7198. (Hmong)
สําคญ: 


 
  Blue Shield 
(866) 346-7198 (Thai)
महवप
ण:       
?  ,    
        

     
   
:
       Blue Shield ID 
   
/   ,  (866) 346-7198   
(Hindi)
:
ານສາມາດ
ານ
ດໝາຍນ
ໄດ
?
າອ
ານບ
ໄດ
, ພວກເຮ
ສາມາດໃຫ
ບາງຄ
ນຊ
ວຍ
ານໃຫ
ານ
ໄດ
.
ານຍ
ສາມາດ
ໃຫ
ແປ
ດໝາຍນ
ເປ
ນພາສາຂອງ
ານໄດ
.
າລ
ຄວາມຊ
ວຍເຫ
ອແບບ
ເສຍ
, ກະ
ນາ
ໂທຫາເບ
ໂທຂອງຝ
າຍ
ການສະມາ
/
ກຄ
ໃນທ
ນທ
ເບ
ໂທລະ
ບຢ
ານ
ງບ
ດສະມາ
Blue Shield ຂອງທ
ານ,
ໂທໄປຫາເບ
(866) 346-7198. (Laotian)
blueshieldca.com
Notice of the Availability of Language Assistance Services
Blue Shield of California Life & Health Insurance Company
No Cost Language Services. You can get an interpreter. You can get documents read to you
and some sent to you in your language. For help, call us at the number listed on your ID card or
1-866-346-7198. For more help call the CA Dept. of Insurance at 1-800-927-4357.
English
Servicios de idiomas sin costo. Puede obtener un intérprete. Le pueden leer documentos y que le
envíen algunos en español. Para obtener ayuda, llámenos al número que figura en su tarjeta de
identificación o al 1-866-346-7198. Para obtener más ayuda, llame al Departamento de Seguros de
CA al 1-800-927-4357.
Spanish
。您可獲得口譯員服務。可以用中文把文件唸給您聽有些文件有中文的版本也可以把這些文
件寄給您。欲取得協助,請致電您的保險卡所列的電話號碼,或撥打
1-866-346-7198
與我們聯絡。欲取得其他
協助,請致電
1-800-927-4357
與加州保險部聯絡。
Chinese
Các Dch V Tr Giúp Ngôn Ng Min Phí. Quý v có th đưc nhn dch v thông dch. Quý v có th đưc
ngưi khác đc giúp các tài liu và nhn mt s tài liu bng tiếng Vit. Đ đưc giúp đ, hãy gi cho chúng tôi
ti s đin thoi ghi trên th hi viên ca quý v hoc 1-866-346-7198. Đ đưc tr giúp thêm, xin gi S Bo
Him California ti s 1-800-927-4357.
Vietnamese
무료
통역
서비스
.
귀하는
한국어
통역
서비스를
받으실
있으며
한국어로
서류를
낭독해주는
서비스를
받으실
있습니다
.
도움이
필요하신
분은
귀하의
ID
카드에
나와있는
안내
전화
: 1-866-346-7198
번으로
문의해
주십시오
.
보다
자세한
사항을
문의하실
분은
캘리포니아
보험국
,
안내
전화
1-800-927-4357
번으로
연락해
주십시오
.
Korean
Walang Gastos na mga Serbisyo sa Wika. Makakakuha ka ng interpreter o tagasalin at
maipababasa mo sa Tagalog ang mga dokumento. Para makakuha ng tulong, tawagan kami sa
numerong nakalista sa iyong ID card o sa 1-866-346-7198. Para sa karagdagang tulong, tawagan
ang CA Dept. of Insurance sa 1-800-927-4357
Tagalog
Անվճար
Լեզվական
Ծառայություններ։
Դուք
կարող
եք
թարգման
ձեռք
բերել
և
փաստաթղթերը
ընթերցել
տալ
ձեզ
համար
հայերեն
լեզվով։
Օգնության
համար
մեզ
զանգահարեք
ձեր
ինքնության
(ID)
տոմսի
վրա
նշված
կամ
1-866-346-7198
համարով։
Լրացուցիչ
օգնության
համար
1-800-927-4357
համարով
զանգահարեք
Կալիֆորնիայի
Ապահովագրության
Բաժանմունք։
Armenian
Беслпатные услуги перевода. Вы можете воспользоваться услугами переводчика, и ваши
документы прочтут для вас на русском языке. Если вам требуется помощь, звоните нам по
номеру, указанному на вашей идентификационной карте, или 1-866-346-7198. Если вам
требуется дополнительная помощь, звоните в Департамент страхования штата Калифорния
(Department of Insurance), по телефону 1-800-927-4357.
Russian
日本語で通訳をご提供し、書類をお読みします。サービスをご希望の方は、IDカー
ド記載の番号または
1-866-346-7198
までお問い合わせください。更なるお問い合わせは、カリフォルニア州
保険庁、
1-800-927-4357
までご連絡ください
Japanese
تﺎﻣﺪﻧﺎﺠﻣ نﺎﺑز ﮫﺑ طﻮﺑﺮﻣ. ﺪﻧﻮﺷ هﺪﻧاﻮﺧ نﺎﺘﯾاﺮﺑ ﯽﺳرﺎﻓ نﺎﺑز ﮫﺑ کراﺪﻣ ﺪﯿﺋﻮﮕﺑ و ﺪﯿﻨﮐ هدﺎﻔﺘﺳا ﯽھﺎﻔﺷ ﻢﺟﺮﺘﻣ ﮏﯾ تﺎﻣﺪﺧ زا ﺪﯿﻧاﻮﺘﯿﻣ. ی ا
هرﺎﻤﺷ ﻦﯾا ﺎﯾ و ﺖﺳا هﺪﺷ ﺪﯿﻗ ﺎﻤﺷ ﯽﺋﺎﺳﺎﻨﺷ ترﺎﮐ یور ﮫﮐ ﯽﻨﻔﻠﺗ هرﺎﻤﺷ ﻖﯾﺮط زا ﺎﻣ ﺎﺑ،ﮏﻤﮐ ﺖﻓﺎﯾرد1-866-346-7198 ﺪﯾﺮﯿﮕﺑ سﺎﻤﺗ. یاﺮﺑ
ﮫﺑ ،ﺮﺘﺸﯿﺑ ﮏﻤﮐ ﺖﻓﺎﯾردCA Dept. of Insurance ) ﺎﯿﻧﺮﻔﯿﻟﺎﮐ ﮫﻤﯿﺑ هرادا ( هرﺎﻤﺷ ﮫﺑ1-800-927-4357 ﺪﯿﻨﮐ ﻦﻔﻠﺗ.Persian
blueshieldca.com
ਮੁਫ਼ਤ
ਭਾਸ਼ਾ
ਸੇਵਾਵਾਂ
:





























(ID)

'



'


1-866-346-7198 '

'











1-800-927-4357 '



Punjabi





    

1-866-346-7198

   

1-800-927-4357
Khmer
ﺔﻘﻠﻜﺗ نوﺪﺑ ﺔﻤﺟﺮﺗ تﺎﻣﺪﺧ. ﻐﻠﻟﺎﺑ ﻚﻟ ﻖﺋﺎﺛﻮﻟا ةءاﺮﻗ و ﻢﺟﺮﺘﻣ ﻲﻠﻋ لﻮﺼﺤﻟا ﻚﻨﻜﻤﯾﺔﯿﺑﺮﻌﻟا ﺔ . ﻞﺼﺗا ،ةﺪﻋﺎﺴﻤﻟا ﻲﻠﻋ لﻮﺼﺤﻠﻟ
ﻢﻗﺮﻟا ﻲﻠﻋ وأ ﻚﺘﯾﻮﻀﻋ ﺔﻗﺎﻄﺑ ﻲﻠﻋ ﻦﯿﺒﻤﻟا ﻢﻗﺮﻟا ﻲﻠﻋ ﺎﻨﺑ1-866-346-7198 . ،تﺎﻣﻮﻠﻌﻤﻟا ﻦﻣ ﺪﯾﺰﻤﻟا ﻲﻠﻋ لﻮﺼﺤﻠﻟ
ﻢﻗﺮﻟا ﻲﻠﻋ ﺎﯿﻧرﻮﻔﯿﻟﺎﻛ ﺔﯾﻻﻮﻟ ﻦﯿﻣﺄﺘﻟا ةرادﺈﺑ ﻞﺼﺗا1-800-927-4357.
Arabic
Cov Kev Pab Txhais Lus Tsis Them Nqi. Koj yuav thov tau kom muaj neeg los txhais lus rau koj thiab kom
neeg nyeem cov ntawv ua lus Hmoob. Yog xav tau kev pab, hu rau peb ntawm tus xov tooj nyob
hauv koj daim yuaj ID los sis 1-866-346-7198. Yog xav tau kev pab ntxiv hu rau CA lub Caj Meem Fai
Muab Kev Tuav Pov Hwm ntawm 1-800-927-4357
Hmong
 





 




1-866-346-7198



 

1-800-927-4357
Thai


































,

ID






,

1-866-346-7198











(CA Dept. of Insurance)

1-800-927-4357



Hindi
Doo b11h 7l7n7g0 saad bee y1t’i’ bee an1’1wo’. D77 sh1 ata’halne’doo7g7 h0l=-doo n7n7zingo 47 b7ighah. Naaltsoos
naanin1h1jeeh7g7 shich’8’ y7idooltah 47 doodag0 [a’ shich’8’ 1dooln77[ n7n7zingo b7ighah. Sh7k1 a’doowo[ n7n7zingo
nihich’8’ b44sh bee hod7ilnih d00 n1mboo 47 d77 ninaaltsoos doot[‘7zh7g7 bee n47ho’d7lzin7g7 bine’d44’ bik11’ 47 doodag0
47 (866)346-7198j8’ hod77lnih. H0zh= sh7k1 an11’doowo[ n7n7zingo 47 d77 b4eso 1ch’22h naa’nil bi[ haz’32j8’
1-800-927-4357j8 hod77lnih.
Navajo
.
ານສາມາດ
ເອ
າຜ
ແປພາສາໄດ
.
ານສາມາດ
ໃຫ
ານເອກະສານໃຫ
ານ
ແລະ
ເອກະສານບາງ
າງ
ເປ
ນພາສາຂອງທ
ານ.
າລ
ຄວາມຊ
ວຍເຫ
, ໃຫ
ໂທຫາພວກເຮ
ຕາມເບ
ໂທລະ
ບທ
ໃນ
ປະ
າຕ
ຂອງ
ານ
ໂທຫາເບ
1-866-346-7198.
າລ
ຄວາມ
ວຍເຫ
ເພ
ເຕ
ມໂທຫາ ພະແນກ ປະ
ໄພຂອງ
ດຄາລ
ເນໄດ
ເບ
1-800-927-4357.
Laotian