COMPANY’S NONDISCRIMINATION NOTICE

Western Dental Services, Inc. and EyeMax Vision Plan, Inc. (collectively, “Company”) complies with applicable State and Federal civil rights laws and does not discriminate on the basis of age, race, creed, color, national origin, ancestry, disability, religion, sex, gender, gender identity or expression, sexual orientation, marital status, honorably discharged veteran or military status, or any other protected category. 

Company:

Provides appropriate aids and services, free of charge, to people with disabilities to communicate effectively with us, such as:

  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides language assistance services, free of charge, to people whose primary language is not English, such as:

  • Qualified interpreters
  • Information written in other languages

If you need these services, contact the Western Dental’s Member Service Department at 1-800-992-3366.

If you believe that Company 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/complaint in the following ways:

Please call the WDS Member Service Department at 1-800-992-3366 if you need help submitting or writing your grievance form.

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. You can mail it to:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, DC 20201

Toll-free: 1-800-368-1019

TDD: 1-800-537-7697

 

You can also send it electronically to a website through the Office for Civil Rights Complaint Portal at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.

English

ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-800-992-3366 (TTY: 714-571-3624).

Español (Spanish)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-992-3366(TTY: 714-571-3624).

繁體中文(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1-800-992-3366(TTY: 714-571-3624).

Tiếng Việt(Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số1-800-992-3366(TTY: 714-571-3624).

Tagalog(Tagalog - Filipino)

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa1-800-992-3366(TTY: 714-571-3624).

한국어 (Korean)

주의:한국어를사용하시는경우,언어지원서비스를무료로이용하실수있습니다.1-800-992-3366(TTY: 714-571-3624)번으로전화해주십시오.

Հայերեն(Armenian)

ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝Եթեխոսումեքհայերեն,ապաձեզանվճարկարողենտրամադրվելլեզվականաջակցությանծառայություններ:Զանգահարեք1-800-992-3366(TTY (հեռատիպ)՝714-571-3624):

فارسی (Farsi)

توجه: اگر به فارسی صحبت می کنید ، خدمات کمک به زبان ، بصورت رایگان ، در دسترس شما است. با شماره 1-800-992-3366 تماس بگیرید (TTY: 714-571-3624).

Русский(Russian)

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-992-3366(телетайп: 714-571-3624).

日本語(Japanese)

注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-992-3366(TTY: 714-571-3624)まで、お電話にてご連絡ください。

عربى (Arabic)

تنبيه: إذا كنت تتحدث العربية ، فإن خدمات المساعدة اللغوية مجانية لك. اتصل برقم 1-800-992-3366 (TTY: 714-571-3624).

ਪੰਜਾਬੀ(Punjabi)

ਿਧਆਨਿਦਓ:ਜੇਤੁਸੀਂਪੰਜਾਬੀਬੋਲਦੇਹੋ,ਤਾਂਭਾਸ਼ਾਿਵੱਚਸਹਾਇਤਾਸੇਵਾਤੁਹਾਡੇਲਈਮੁਫਤਉਪਲਬਧਹੈ।1-800-992-3366(TTY: 714-571-3624)'ਤੇਕਾਲਕਰੋ।

ខ្មែរ (Cambodian)

ការប្រុងប្រយ័ត្នៈប្រសិនបើអ្នកនិយាយភាសាខ្មែរសេវាកម្មជំនួយភាសាដោយមិនគិតថ្លៃអាចរកបានសម្រាប់អ្នក។ ទូរស័ព្ទមកលេខ 1-800-992-3366 (TTY: 714-571-3624) ។

Hmoob (Hmong)

LUSCEEV:Yog tias koj hais lus Hmoob, cov kev pab txog lus,muaj kev pab dawb rau koj. Hu rau 1-800-992-3366(TTY: 714-571-3624).

हिंदी (Hindi)

ध्यान दें: यदि आप हिंदी, भाषा सहायता सेवाएं, नि: शुल्क बोलते हैं, तो आप के लिए उपलब्ध हैं। 1-800-992-3366 (TTY: 714-571-3624) पर कॉल करें।

ภาษาไทย (Thai)

ข้อควรระวัง: ถ้าคุณพูดภาษาไทยได้คุณสามารถใช้บริการสนับสนุนภาษาได้ฟรีโทร 1- 888-665-4621 (TTY: 714-571-3624).