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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 />Nondiscrimination 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 M utual 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 another way on the basis of race, color, national origin, age, disability orsex, 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: CivilRightsCoordii)ator@MedMutual.com <br />You can alsofile 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/portalAobby.isf <br />■ By mail at: <br />U.S. Department of Health and Human Services <br />200 Independence Avenue, SW Room 509E <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.html <br />APPENDIX "A" <br />PPO OPTION 1 <br />Prnid!lct. Illry I'. f;_(:nI•'} 'ri{ Jil'al't ,(,i li ;{1bV lr" t!r ;E P, :`o'r! ti';i I!"! <br />of la 1 it(}r ..Urr`.•l�lilt.' <br />