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QUESTIONS ABOUT YOUR BENEFITS OR OTHER INQUIRIES ABOUT YOUR HEALTH INSURANCE <br />SHOULD BE DIRECTEDTO MEDICAL MUTUAUS CUSTOMER CARE DEPARTMENTAT 1-800.382-5729. <br />Nondiscrirnination Notice <br />Medical Mutual of Ohio complies with applicable federal civil rights laws and does not discriminate on the <br />basis of race, color, national origin, age, disability or sex in its operation of health programs and activities. <br />Medical Mutual does not exclude people or treat them differently because of race, color, national origin, age, <br />disability or sex in its operation of health programs and activities. <br />■ Medical Mutual provides free aids and services to people with disabilities to communicate effectively with <br />us, such as qualified sign language interpreters, and written information in other formats (large print, audio, <br />accessible electronic formats, etc.). <br />• Medical Mutual provides free language services to people whose primary language is not English, such as <br />qualified interpreters and information written in other languages, <br />If you need these services or if you believe Medical Mutual failed to provide these services or discriminated <br />in anotherway on the basis of race, color, national origin, age, disability or sex, with respect to your health <br />care benefits or services, you can submit a written complaint to the person listed below. Please include <br />as much detail as possible in your written complaint to allow us to effectively research and respond. <br />Civil Rights Coordinator <br />Medical Mutual of Ohio <br />2060 East Ninth Street <br />Cleveland, OH 44115-1355 <br />MZ; 01-10-1900 <br />Email: Civil Rights Coordinator@MedMutual.com <br />You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, <br />• Electronically through the Office for Civil Rights Complaint Portal available at: <br />ocrportal.hhs.gov/ocr/portal/lobby.isf <br />■ By mail at: <br />U.S. Department of Health and Human Services <br />200 Independence Avenue, SW Room 509F <br />HHH Building <br />Washington, DC 20201-0004 <br />■ By phone at: <br />(800) 368-1019 (TDD: (800) 537-7697) <br />■ Complaint forms are available at: <br />hhs.gov/ocr/office/file/index.htmi <br />APPENDIX "A" <br />PPO OPTION 1 <br />i''I'fl(I;iCI� I-rl k. [; U3fl I-V bf' lII1:1Fi-Ildrl'i1 Rli by one Ci ilS Eiib"r ilf al'!C',, nL:Ch aS Mii L:dIC al IlF'6hh 11"111 ii� i <br />"C11 ijUrctiilCli.if l.iilir:I or I"CltlsmnieiS Uli` <br />