managed care plan choice book

To the addressee or guardian of:270IMC010031C-0000001-19-7-M-M

JOHN SAMPLE1234 SAMPLE STREETANYTOWN CA 90000

CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESHealth Care Options, P.O. Box 989009West Sacramento, CA 95798-9860

Choose A PlanSee inside for choice forms

Department of Health Care Services

MU_0004052_ENG_0916

Managed Care Plan Choice Book

Cal MediConnect and Medi-Cal Managed Care Plans

IMC999999999-02/26/15

If you or your family members have any questions, call Health Care Options, toll-free at the numbers listed below:

Representatives are available Monday – Friday 8:00 a.m. to 5:00 p.m.

English 1-844-580-7272 Written materials are available

اللغة العربيةArabic1-844-580-7272تتوفر معلومات مطبوعة

ՀայերենArmenian1-844-580-7272Գրավոր նյութեր գոյություն ունեն

ភាសាខ្មែរCambodian1-844-580-7272មានផ្ដល់ឯកសារសរសសរជាលាយលក្ខណ៍អក្សរ

粵語Cantonese1-844-580-7272可以提供書面材料

فارسیFarsi1-844-580-7272مطالب به زبان های زیر موجود است:

Hmoob Hmong 1-844-580-7272 Cov lus uas sau hauv ntawv los muaj thiab

한국어Korean1-844-580-7272서면 자료의 이용이 가능합니다

國語Mandarin1-844-580-7272可以提供書面材料

РусскийRussian1-844-580-7272Доступны материалы в письменном виде

Español Spanish 1-844-580-7272 Se dispone de material escrito

Tagalog Tagalog1-844-580-7272 May mga nakasulat na materyales

Tiếng ViệtVietnamese1-844-580-7272 Có các tài liệu dưới dạng văn bản

Other Languages1-844-580-7272

TTY1-800-430-7077

MU_0004052_LANG2_0916

IMC

Program of All-Inclusive Care for the Elderly (PACE)These plans cover both Medicare and Medi-Cal. If you qualify for PACE, services are provided in a PACE center. You must still choose a Cal MediConnect plan in Choice A OR a Medi-Cal plan in Choice B listed on your choice form. While we are checking your eligibility for PACE, you will not be enrolled in Cal MediConnect or a Medi-Cal Managed Care plan. We will need to know your choice just in case you do not qualify for PACE.

LA_0004089_ENG_0916

Brandman Centers for Senior Care Toll Free: 1-855-774-8444 (TTY: 1-818-774-3194) brandmanseniorcare.org

Altamed Senior BuenaCare Toll Free: 1-877-462-2582 (TTY: 1-800-735-2922) altamed.org/seniorservices

Los Angeles County

Medi-Cal Managed CareThese plans cover only Medi-Cal. If you want to keep your Medicare the way it is now, choose one of the Medi-Cal plans under Choice B on the Plan Choice Form.

Cal MediConnectThese plans cover both Medicare and Medi-Cal. You can choose one of these Cal MediConnect plans under Choice A on the Plan Choice Form.

Health Net Comm SolutionsPlan PartnersHealth Net 1-800-327-0502 • (TTY: 1-800-431-0964) healthnet.com

Molina Health Plan 1-888-665-4621• (TTY: 1-800-479-3310) molinahealthcare.com

Call the health plans to ask if they work with your doctors and other health care providers. You may also ask for a list of doctors and providers that they work with.

Care1st Cal MediConnect Plan 1-855-905-3825 • (TTY: 711) care1st.com/ca/calmediconnect Health Net Cal MediConnect 1-888-788-5395 • (TTY: 711) healthnet.com/calmediconnect

L.A. Care 1-888-522-1298 • (TTY: 711) calmediconnectla.orgMolina Dual Options 1-855-665-4627 • (TTY: 711) molinahealthcare.com/duals

L.A. Care Health PlanPlan Partners Anthem Blue Cross 1-800-407-4627 • (TTY: 1-888-757-6034) anthem.com

Care1st Health Plan 1-800-605-2556 • (TTY: 1-800-735-2929) care1st.comKaiser Permanente 1-800-464-4000 • (TTY: 1-800-777-1370) healthy.kaiserpermanente.org

L.A. Care 1-888-839-9909 • (TTY: 1-866-522-2731) lacare.org

February 26, 2015To the addressee or guardian of:

u IMC - *999999999IMC022615* tJOHN SAMPLE1234 SAMPLE STREETSAMPLE CITY CA 99999

270IMC010031C-000003-19-7-M-MMU_IA04051_ENG1_0916

You are getting this letter because you are eligible for BOTH Medicare and Medi-Cal. You must choose a health plan for your Medi-Cal benefits (including Long-Term Services and Supports). You have many health plans to choose from to receive your Medi-Cal benefits. You can choose a Cal MediConnect plan, which covers all of your Medicare and Medi-Cal benefits together under one plan, and includes extra benefits. You can also choose to keep your Medicare separate and choose a Medi-Cal Managed Care plan for your Medi-Cal benefits. You also may be eligible to apply for a Program of All-Inclusive Care for the Elderly (PACE) plan, if you are over 55 and meet certain requirements.

This choice book explains the benefits of each health plan and explains how to enroll into the plan that best fits your health care needs. Please read the choice book carefully.

You have the following choices:

• Join a Cal MediConnect Plan. Cal MediConnect combines all your Medicare and Medi-Cal benefits into one, convenient health plan. Cal MediConnect is only available in certain counties. If you move, contact your eligibility worker to learn about your options.

• Join a Medi-Cal Managed Care Plan. You can choose to keep your Medicare and Medi-Cal separate, but you must still join a Medi-Cal Managed Care plan for your Medi-Cal benefits. Joining a Medi-Cal Managed Care plan will not change your Medicare benefits.

If eligible, you may also apply for Program for All-Inclusive Care for the Elderly (PACE). PACE plans cover all Medicare and Medi-Cal benefits. Services are provided at PACE centers and at home. You must qualify for PACE. If you choose PACE, you must still select a Cal MediConnect or Medi-Cal Managed Care plan in case you do not qualify for PACE.

Enclosed in this choice book is your health plan enrollment choice form, please complete and return the choice form by

State of California-Health and Human Services Agency

Department of Health Care ServicesP.O. Box 989009, West Sacramento, CA 95798-9850

IMC-999999999-02/26/15

4/24/2015.

MU_IA04051_ENG2_0916

If you do not make a choice, we will choose a Medi-Cal Managed Care plan for you.

You can choose a plan that fits your needs at any time before

After we receive your plan choice, you will receive a letter with your chosen health plan’s name and start date for your coverage. Your new health plan will also send you helpful information about how to get the care you need once you are enrolled. You can change your health plan at anytime by contacting Health Care Options toll-free at 1-844-580-7272.

The effective date of your plan enrollment will depend on when we receive your plan choice but it wont be later than Your plan could be effective as early as the first of next month.

If you have questions, want to enroll over the phone, need this packet in another language or alternative format, please call Health Care Options toll-free at 1-844-580-7272, between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday. TTY/TDD users please call 1-800-430-7077.

If you need help completing the choice form, please see the Health Care Options presentation schedule inside this choice book for site locations near you or visit us online at healthcareoptions.dhcs.ca.gov.

If you’d like more information on the specific benefits offered by each health plan, please contact the health plan directly. Health plan contact information is located in the front of this choice book. You can also call the Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. HICAP provides free and objective counseling and can help you understand your plan options and assist in filling out the forms in this choice book.

We look forward to working with you to keep you healthy.

4/24/2015.

5/1/2015.

MU_0004071_ENG_0916

What are my choices?You must choose one of these options. Your choices are listed below. There is no cost to join a health plan.

Choice A: Enroll in a Cal Medi-Connect plan. This plan:

• Combines all of the Medicare and Medi-Cal benefits and services you receive now into a single plan with added benefits.

• Gives additional transportation to medical services and vision benefits.

• Gives you a Care Coordinator to help you with your health care needs. A Care Coordinator will be assigned to you when you join a Cal MediConnect plan.

• Ensures Cal MediConnect doctors, specialists, and other approved providers will work together to get you the care you need.

Choice B: Stay with regular Medicare AND enroll in a Medi-Cal Managed Care plan for your Medi-Cal benefits.

• If you choose to stay with regular Medicare, you MUST ALSO choose a Medi-Cal Managed Care plan to receive your Medi-Cal benefits.

• If you are already in a Medi-Cal Managed Care plan and choose to stay in regular Medicare, you can choose to stay in that Medi-Cal Managed Care plan or choose a different Medi-Cal Managed Care plan.

What if I don’t choose a Health Plan?If you do NOT make a choice, you will be automatically enrolled in the Medi-Cal Managed Care plan that we have chosen for you.

MU_0004070_ENG_0916

Call Toll Free by• Health Care Options toll free at 1-844-580-7272, Monday

through Friday, 8:00 a.m. to 5:00 p.m. For TTY users, call 1-800-430-7077.

ORVisit Health Care Options in Person

You can visit a Health Care Options presentation site and speak to someone in person. To find the nearest location see the enclosed presentation schedule or contact Health Care Options:

– 1-844-580-7272 for more information. For TTY users, call 1-800-430-7077.

– Visit www.healthcareoptions.dhcs.ca.gov and click “Presentation Sites” link.

ORMail In Your Health Plan Choice Form by Complete the Health Plan Choice Form in this book and mail in the postage paid envelope provided.

How to Make a Health Plan ChoiceThere are several ways you can make a health plan choice.

GET MORE INFORMATION

For free, in-person counseling, contact the Health Insurance

Counseling and Advocacy Program (HICAP). HICAP provides free and objective information and counseling on health plans. Call: 1-800-434-0222 or visit: aging.ca.gov/hicap

4/30/2015

4/24/2015

Health Plan Choice Form Instructions

MU_PCE4062_ENG_0916

These instructions will help you fill out the Health Plan Choice Form on the next page to select the option that works best for you.

For help filling out the form, call Health Care Options at 1-844-580-7272.

STEP 1: Tell us about yourselfPlease fill in any blanks and correct any errors on the Health Plan Choice Form. If your name and other information are correct, you may proceed to Step 2.

STEP 2: Choose a health planPlease choose a plan. If you do NOT make a choice, you will be automatically enrolled into a Medi-Cal Managed Care plan.

• Choice A - If you want to get your Medicare and Medi-Cal benefits combined in one plan, fill in the circle ( ) to the left of the Cal MediConnect plan you want.

• Choice B - If you want to keep your Medicare separate from your Medi-Cal, you must choose a Medi-Cal plan for your Medi-Cal benefits. Fill in the circle ( ) to the left of the Medi-Cal plan you want.

If you’d like to get your Medicare and Medi-Cal benefits combined in one plan and receive care at dedicated PACE centers, fill in the circle for the PACE plan you want. In case you do not qualify, you MUST still choose a plan in Choice A or Choice B.

• To qualify for the Program of All-Inclusive Care for the Elderly (PACE), you have to meet certain requirements such as:

• Be age 55 or older,

• Live in a zip code served by a PACE organization

• Be able to live in your home and community safely, and

• Meet a level of need for skilled nursing home care, as determined by the PACE organization’s interdisciplinary team assessment and certified by the Department of Health Care Services.

Ask your doctors and other health care providers to see which plans they work with and check if your prescription drugs are covered. You may also contact the plans directly to get a list of doctors and providers. Telephone numbers for the plans are listed in the front page of this choice book.

Fill in the Doctor/Clinic Codes - Optional (if known) Doctor/Clinic Codes can be found by asking your Doctor/Clinic or in the Health Plan Provider Directory located at: http://www.dhcs.ca.gov/services/Pages/MMCDProvInfoNet.aspx

STEP 3: Read the important information on the back before signing. Please read the information on the back of the form, then sign and date your completed Health Plan Choice Form. Use the envelope in this Choice Book to mail your completed Health Plan Choice Form. You do not need a stamp if you use the enclosed envelope.

800 L.A. Care801 Health Net816 Molina Dual Options817 Care1st

STEP 3: Read the important information on the back before signing. I understand that by filling out and signing this form, I am choosing how to get my health care.

Applicant’s Signature Date OR Authorized Representative Signature (if any) Date

Confidential

Health Plan Choice Form

STEP 1: Tell us about yourself:

California Department of Health Care Services

P.O. Box 989009W. Sacramento, CA 95798-9850

Keep my Medicare separate AND choose a Medi-Cal Managed Care plan.

Choose one of these Medi-Cal Managed Care plans to get your Medi-Cal benefits:

Combine my Medicare and Medi-Cal benefits in one plan.

Choose one of these Cal MediConnect plans:

CHOICE A

STEP 2: Choose your health plan:

(___ ___ ___) ___ ___ ___ -___ ___ ___ ___ Month Day Year(Area Code) Phone Number

CHOICE BOR

___ ___-___ ___-___ ___ Zip Code Date of Birth

Sex: Male Female

If pregnant, estimate due date ___ ___-___ ___-___ ___

Address, City

First Name, Last Name Social Security Number___ ___ ___ -___ ___ -___ ___ ___ ___

MU_0004073_ENG1_0916

PACE Plan:Program of the All-Inclusive Care for the Elderly (PACE): You may qualify for PACE (see instructions). If you want to get your Medicare and Medi-Cal benefits combined in a PACE plan, fill out this option in addition to Choice A or B.

If you do not qualify, you will get your care through the Choice A or Choice B plan that you chose above in Step 2.

Doctor/Clinic Code: (optional)

Doctor/Clinic Code: (optional)

Use this form to join or change a health plan. For FREE help with this form, contact Health Care Options at 1-844-580-7272. Mail completed form to California Department of Health Care Services, Health Care Options, P.O. Box 989009, West Sacramento, CA 95798-9850. Please print clearly using blue or black ink.

JOHN SAMPLE

1234 SAMPLE STREET SAMPLE CITY 99999

*CCIPB*CCIPB

*CCIPB*CCIPB

*M-0-999999999-IMC*M-0-999999999-IMC

304 L.A. Care Health PlanPlan Partners

CF Care1st Partner Plan, LLCKA KP Cal, LLCLA L.A. Care Health PlanBC Anthem Blue Cross Partnrshp

352 Health Net Comm SolutionsPlan Partners

HN Health Net Comm SolutionsMO Molina Healthcare Partner

052 AltaMed Senior BuenaCare060 Brandman Cent for Sen Care

SAMPLE N

OT FOR OFFIC

IAL USE

Privacy Statement

The Department of Health Care Services will keep the information you provide. It is used only to enroll and/or disenroll people that are eligible for Medi-Cal managed care. The laws that allow this are in the Welfare and Institutions Code, Section 10416.5, 14016.6, 14087.305, 14087.31, 14087.35, 14087.36, 14087.38, 14087.96, 14088, 14089, 14089.5, and 14631, and California Code of Regulations, Section 51085.5.

Only other government agencies that relate to the Medi-Cal program can see the information you provide. However, any information that is being used in an investigation or lawsuit cannot be seen. If you want to see your Medi-Cal file, contact the Department of Health Care Services at the address on the other side of this form.

Read this important information before you sign the form.

California Department of

Health Care ServicesP.O. Box 989009

W. Sacramento, CA 95798-9850

If I join the Medi-Cal KP Cal, LLC (Kaiser Permanente): I understand that Kaiser requires binding arbitration for my Medi-Cal benefits. This means that I give up my right to a jury or court trial for medical malpractice and other disagreements about benefits and services. Instead, I would help choose independent professionals who would make a decision about the problem. I can still ask for a Medi-Cal State Hearing.

If I choose PACE, I will be contacted to see if I meet the eligibility requirements for enrollment into the PACE health plan. I must meet the nursing home level of care and still be able to live safely in a community setting.

By completing this enrollment application for a Cal MediConnect plan, I agree to the following: Cal MediConnect plans are Medicare-Medicaid plans that have a contract with the State of California and the Federal government. I will need to keep my Medicare Parts A, B and D and Medi-Cal. I can be in only one Medicare plan at a time, and I understand that my enrollment in the plan selected will automatically end my enrollment in any other Medicare health plan or Medicare prescription drug plan.

I understand that prescription drugs are covered, but not always the same ones I’m already taking. I understand that I’ll be able to receive at least one 30-day supply of the prescription drugs I currently take anytime during the first 90 days of coverage in a Cal MediConnect plan. I understand that I may be able to continue seeing the doctors I go to now for a period up to six (6) months for Medicare services and a period of up to twelve (12) months for Medi-Cal services from the effective date of enrollment in a Cal MediConnect plan. I must contact the Cal MediConnect plan for information on how to do this. My provider must be willing to work with my plan and/or accept payment. I further understand that the Cal MediConnect plan has providers and pharmacies that I must use to

get health care services, except for non-routine, emergency situations.

Cal MediConnect plans serve a specific service area. If I move out of the area covered by the plan chosen, I need to notify the plan so I can disenroll and find a new plan in my new area.

I understand that beginning on the date my Cal MediConnect coverage begins, I must get all of my health care from my new plan, except for emergency or urgently needed services or out-of-area dialysis services. Services authorized by my Cal MediConnect plan and other services contained in my plan's Evidence of Coverage document will be covered. Without authorization, NEITHER Medicare, Medi-Cal NOR my Cal MediConnect plan WILL PAY FOR THE SERVICES.

Release of Information: By joining this Medicare and Medicaid plan or PACE, I acknowledge that the plan I selected will release my information to Medicare and other plans as is necessary for treatment, payment and health care operations. I also acknowledge that my Cal MediConnect plan will release my information, including my prescription drug event data, to Medicare, who may release it for research and other purposes which follow all applicable Federal statutes and regulations. The information on this enrollment form is correct to the best of my knowledge. I understand that if I intentionally provide false information on this form, I will be disenrolled from the plan.

I understand that my signature (or the signature of the person authorized to act on my behalf under the laws of California on this application) means that I've read and understand the contents of this application. If signed by an authorized individual, this signature certifies: 1) this person is authorized under State law to complete this enrollment and 2) documentation of this authority is available upon request from Medicare.

MU_0004073_ENG2_0916

Health Plan Choice Form

IMAGE

MISSING

You are receiving this form because you are eligible to enroll in a new Medi-Cal health plan. Your new plan will use this form to make sure you get needed care. Pleasefillinthecirclewithblackorbluepenfor the answers that apply to you. Complete one form for each person in your family who is enrolling in a new Medi-Cal health plan. If you have questions, please call Health Care

Options, toll free at 1-800-430-4263 Monday through Friday, between 8:00 a.m. and 5:00 p.m. TDD/TTY users should dial 1-800-430-7077.

Please return completed form with your Medi-Cal Choice Form or mail separately to:CA Department of Health Care Services Health Care Options - PO Box 989009 West Sacramento, CA 95798-9850

Health Information Form

MU_0003754_ENG_0912CONFIDENTIAL

I understand that this information will be disclosed to Health Care Options and my new plan.

Signature: Date Signed:

When you become a health plan member, DHCS will send this information to your Medi-Cal health plan.

If you think you need to see a doctor before your Medi-Cal health plan contacts you, you should go to the doctor or hospital at that time.

Filling out this form is voluntary. You will not be denied care based on your confidential answers.

1. Do you need to see a doctor within the next 60 days? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

2. Do you take 3 or more prescription medicines each day? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

3. Do you see a doctor regularly for a mental health condition such as depression, bipolar disorder, or schizophrenia? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

4. Have you been to the emergency room two or more times in the last 12 months? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

5. Have you been admitted to the hospital in the last 12 months? . . . . . . . . . . . . . . . . . . . . Yes No

6. Have you needed help with personal care, such as bathing, getting dressed, or changing bandages in the last 6 months? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

7. Are you using medical equipment or supplies, such as a hospital bed, wheelchair, walker, oxygen, or ostomy bags? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

8. Do you have a condition that limits your activities or what you can do? . . . . . . . . . . . . . . . . . Yes No

9. Are you pregnant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No 9a. If Yes, are you currently seeing a doctor for this pregnancy? . . . . . . . . . . . . . . . . . . . . . . Yes No

10. Do you see a doctor regularly for a chronic medical condition? . . . . . . . . . . . . . . . . . . . . . . . Yes No If Yes, fill in all that apply:

Born In: Name of Person Completing Form:

Asthma Cancer Cystic Fibrosis Diabetes Heart Problems Hepatitis High Blood Pressure HIV or AIDS Kidney Disease Seizures Sickle Cell Anemia Tuberculosis Other

Ifnotsignedbybeneficiary,specifyrelationship:Parent of minor Guardian Other representative

*1010*1010

JOHN SAMPLE 2016 *999999999-999999999**999999999-999999999*999999999 - 999999999

MU_CCI3382_ENG_1114

State of California - Health and Human Services Agency Department of Health Care Services

Medi-Cal Managed Care

Non-Medical ExemptionRequest for Non-Medical Exemption from Plan Enrollment

American Indians or Beneficiaries with HIV/AIDS in Coordinated Care Initiative Counties

Dear Medi-Cal Beneficiary: If you are receiving Medi-Cal benefits, you may be required to join a Medi-Cal Managed Care health plan. However, if you are a qualified individual for this exemption and you want to receive medical services through your choice of facility or provider, you may request to be excused from Medi-Cal Managed Care health plan enrollment in order to receive services through a service facility or provider of your choice.

To be excused from plan enrollment you must have a service facility or provider representative complete this form, certifying that you are or will be receiving services from a service facility or provider of your choice. The facility representative must submit this completed form to Health Care Options.

Dear Service Facility or Provider: If you currently provide or will be providing medical services to an individual who is receiving Medi-Cal benefits and that individual is required to enroll in a health plan, completion of this form will enable the individual to receive services through your facility as an alternative to enrollment in a Medi-Cal Managed Care health plan. The exemption form is valid until the individual chooses to enroll in a Medi-Cal Managed Care health plan. This form

may be submitted for beneficiaries who are receiving Medi-Cal services in a Coordinated Care Initiative County and has operating Cal MediConnect health plans and: 1) are American Indian, or 2) have been diagnosed with HIV or AIDS.Mail completed form to: or Fax this form to: Health Care Options (916) 364-0287 P.O. Box 989009 West Sacramento, CA 95798-9850

If you have any questions regarding this form, please call HCO at 1-844-580-7272; TTY/TDD users, call 1-800-430-7077.

Please Print or Type (Ink Only) Each area of this non-medical exemption form must be completed or the form will be returned unprocessed.

1. Beneficiary Name:

Last Name First Name M.I.

2. Beneficiary Medi-Cal I.D. Number (BIC)

3. Name of Service Facility or Provider

I certify that the information I have provided on this form is correct. I understand that the Department of Health Care Services may audit this form to determine if the information provided is accurate.

4a. Authorized Signature of Medi-Cal Provider

4b. Date signed

/ / Month Day Year

4c. Printed name of Medi-Cal Provider

Last Name First Name M.I.

4d. NPI Number used to bill the Medi-Cal Program for this beneficiary

5. Telephone number of Medical Provider

( ) -

6. Fax number of Medical Provider

( ) -

7. Telephone number of Medical Physician

( ) -

8. Fax number of Medical Physician

( ) -

1OZ_

0004

074_

EN

G1_

0916

Do not put m

ore than 4 forms in this envelope

1OZ_0004074_E

NG

2_0916

Health Care OptionsPresentations

Page 1 of 4

MSM-C-M61 LA_LTSS_PRES_ENG1_1016

CITY LOCATION ZIP CODE DAY HCO SITE HOURS LANGUAGES

Canyon Country

County of LA Dept of Public Social Services Santa Clarita Branch 27233 Camp Plenty Road

91351 M - F 8:00am - 12:30pm 1:30pm - 5:00pm English / Spanish

Chatsworth

County of LA Dept of Public Social Services DPSS West Valley Family Service Center 21415 Plummer Street


ComptonCounty of LA Dept of Public Social Services 211 E. Alondra Boulevard


CudahyCounty of LA Dept of Public Social Services 8130 S. Atlantic Avenue


County of LA Dept of Public Social Services San Gabriel Valley Family Service Center 3350 Aerojet Avenue

91731 M - F 8:00am - 12:30pm 1:30pm - 5:00pm

English / Spanish Vietnamese / Cantonese / Mandarin

County of LA Dept of Public Social Services San Gabriel Valley Family Service Center 3352 Aerojet Avenue

91731 M - F 8:00am - 12:30pm 1:30pm - 5:00pm

English / Spanish / Vietnamese / Cantonese / Mandarin

El Monte

Presentation times, dates, and locations are subject to change. Please contact the Health Care Options toll-free number 1-844-580-7272 to verify the schedule before attending. Additional sites may be available at the time of your call. Health Care Options will not be conducting presentations on October 10th due to a staff meeting.

Attend an informative session at one of these convenient locations.

California Health Care Options (HCO) Presentation SitesLos Angeles County

October 2016 Schedule

In-Person Medi-Cal Managed Care Information Just ask for the "Health Care Options"

Representative No Appointment Necessary Free Help To Complete Forms


Page 2 of 4



GlendaleLos Angeles County Dept of Public Social Services 4680 San Fernando Road

91204 M - F 8:00am - 12:30pm 1:30pm - 5:00pm

English / Spanish / Armenian /

Russian / Farsi

LancasterLos Angeles County Dept of Public Social Services 349-B East Avenue K-6


Dept of Public Social Services County of Los Angeles 5445 Whittier Boulevard


Exposition Park Family Service Center County of Los Angeles 3833 S. Vermont Avenue


County of LA Dept of Public Social Services 1740 E. Gage Avenue


T & W 8:00am - 12:30pm 1:30pm - 5:00pm

TH 8:00am - 12:30pm Dept of Public Social Services County of LA 2855 E. Olympic Blvd


Just ask for the "Health Care Options"


English / SpanishLos Angeles County Dept of Public Social Services 4077 N. Mission Road

90032


Los Angeles




In-Person Medi-Cal Managed Care Information


Page 3 of 4



County of Los Angeles 2615 S. Grand Avenue 90007 M - F 8:00am - 12:30pm

1:30pm - 5:00pm English / Spanish

County of LA Dept of Public Social Services 2601 Wilshire Boulevard


Metro Special District #70 2707 S. Grand Avenue 90007 M - F 8:00am - 12:30pm


Dept of Public Social Services Rancho Park District 11110 W. Pico Blvd


Ben F Peery Building County of LA Dept of Public Social Services 10728 S. Central Avenue


County of LA Administration Building 8300 S. Vermont Ave


County of LA Dept of Public Social Services Southwest Special District 1819 Charlie Sifford Drive


Los Angeles

Just ask for the "Health Care Options"






In-Person Medi-Cal Managed Care Information


Page 4 of 4



Los AngelesDept of Public Social Services County of LA 2415 W. 6th Street


Norwalk Norwalk 12727 Norwalk Blvd. 90650 M - F 8:00am - 12:30pm


Pasadena

LA County Dept of Public Social Services Child Support Services 955 N. Lake Avenue


PomonaLA County Dept of Public Social Services 2040 W. Holt Avenue


County of LA Dept of Public Social Services Paramount District Office 2961 East Victoria Street


M - F English / Spanish

T & TH Cambodian

Van NuysZev Yaroslavsky Family Support Center 7555 Van Nuys Blvd.





In-Person Medi-Cal Managed Care Information Just ask for the "Health Care Options"

Representative


No Appointment Necessary Free Help To Complete Forms

RanchoDominguez

90221 8:00am - 12:30pm 1:30pm - 5:00pm

County of LA Dept of Public Social Services 17600 "A" Santa Fe Ave.

To the addressee or guardian of:270IMC010031C-0000001-19-7-M-M

JOHN SAMPLE1234 SAMPLE STREETANYTOWN CA 90000

CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESHealth Care Options, P.O. Box 989009West Sacramento, CA 95798-9860

Choose A PlanSee inside for choice forms

Department of Health Care Services

MU_0004052_ENG_0916

Managed Care Plan Choice Book

Cal MediConnect and Medi-Cal Managed Care Plans

IMC999999999-02/26/15

If you or your family members have any questions, call Health Care Options, toll-free at the numbers listed below:

Representatives are available Monday – Friday 8:00 a.m. to 5:00 p.m.

English 1-844-580-7272 Written materials are available

اللغة العربيةArabic1-844-580-7272تتوفر معلومات مطبوعة

ՀայերենArmenian1-844-580-7272Գրավոր նյութեր գոյություն ունեն

ភាសាខ្មែរCambodian1-844-580-7272មានផ្ដល់ឯកសារសរសសរជាលាយលក្ខណ៍អក្សរ

粵語Cantonese1-844-580-7272可以提供書面材料

فارسیFarsi1-844-580-7272مطالب به زبان های زیر موجود است:

Hmoob Hmong 1-844-580-7272 Cov lus uas sau hauv ntawv los muaj thiab

한국어Korean1-844-580-7272서면 자료의 이용이 가능합니다

國語Mandarin1-844-580-7272可以提供書面材料

РусскийRussian1-844-580-7272Доступны материалы в письменном виде

Español Spanish 1-844-580-7272 Se dispone de material escrito

Tagalog Tagalog1-844-580-7272 May mga nakasulat na materyales

Tiếng ViệtVietnamese1-844-580-7272 Có các tài liệu dưới dạng văn bản

Other Languages1-844-580-7272

TTY1-800-430-7077

MU_0004052_LANG2_0916

IMC

managed care plan choice book

Documents