Form A46163 - Authorization For The Use Or Disclosure Of Health Information Page 4

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Notice Informing Individuals about Nondiscrimination
and Accessibility Requirements
Discrimination is against the law
Blue Shield of California complies with applicable federal civil rights laws and does not
discriminate on the basis of race, color, national origin, age, disability or sex. Blue Shield of
California does not exclude people or treat them differently because of race, color, national
origin, age, disability or sex.
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, age, disability or sex, 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: (916) 350-7405
Email:
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.
Blue Shield of California
50 Beale Street, San Francisco, CA 94105

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