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CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICESHealth Care Options, P.O. Box 989009West Sacramento, CA 95798-9860To the addressee or guardian of:270IMC010031C-0000001-19-7-M-MChoose A PlanSee inside forchoice formsIMC999999999-02/26/15JOHN SAMPLE1234 SAMPLE STREETANYTOWN CA 90000Managed Care PlanChoice BookCal MediConnect and Medi-CalManaged Care PlansIMCDepartment of Health Care ServicesMU 0004052 ENG 0916
Los Angeles CountyCal MediConnectThese plans cover both Medicare and Medi-Cal. You can choose one of theseCal MediConnect plans under Choice A on the Plan Choice Form.Care1st Cal MediConnect Plan1-855-905-3825 (TTY: 711)care1st.com/ca/calmediconnectL.A. Care1-888-522-1298 (TTY: 711)calmediconnectla.orgHealth Net Cal MediConnect1-888-788-5395 (TTY: 711)healthnet.com/calmediconnectMolina Dual Options1-855-665-4627 (TTY: 711)molinahealthcare.com/dualsMedi-Cal Managed CareThese plans cover only Medi-Cal. If you want to keep your Medicare the way it is now, chooseone of the Medi-Cal plans under Choice B on the Plan Choice Form.Health Net Comm SolutionsL.A. Care Health PlanMolina Health Plan1-888-665-4621 (TTY: 1-800-479-3310)molinahealthcare.comCare1st Health Plan1-800-605-2556 (TTY: 1-800-735-2929)care1st.comPlan PartnersHealth Net1-800-327-0502 (TTY: 1-800-431-0964)healthnet.comPlan PartnersAnthem Blue Cross1-800-407-4627 (TTY: 1-888-757-6034)anthem.comKaiser Permanente1-800-464-4000 (TTY: 1-800-777-1370)healthy.kaiserpermanente.orgL.A. Care1-888-839-9909 (TTY: 1-866-522-2731)lacare.orgCall the health plans to ask if they work with your doctors and other health careproviders. You may also ask for a list of doctors and providers that they work with.Program of All-Inclusive Care for the Elderly (PACE)These plans cover both Medicare and Medi-Cal. If you qualify for PACE, services areprovided in a PACE center. You must still choose a Cal MediConnect plan in Choice A OR aMedi-Cal plan in Choice B listed on your choice form. While we are checking your eligibilityfor 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.Altamed Senior BuenaCareToll Free: 1-877-462-2582(TTY: 1-800-735-2922)altamed.org/seniorservicesBrandman Centers for Senior CareToll Free: 1-855-774-8444(TTY: 1-818-774-3194)brandmanseniorcare.orgLA 0004089 ENG 0916
State of California-Health and Human Services AgencyDepartment of Health Care ServicesP.O. Box 989009, West Sacramento, CA 95798-9850February 26, 2015To the addressee or guardian of:u IMC - *999999999IMC022615*tIMC-999999999-02/26/15JOHN SAMPLE1234 SAMPLE STREETSAMPLE CITY CA 99999You are getting this letter because you are eligible for BOTH Medicare and Medi-Cal. Youmust choose a health plan for your Medi-Cal benefits (including Long-Term Services andSupports). 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-Calbenefits together under one plan, and includes extra benefits. You can also choose to keepyour Medicare separate and choose a Medi-Cal Managed Care plan for your Medi-Calbenefits. 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 intothe 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, convenienthealth plan. Cal MediConnect is only available in certain counties. If you move, contactyour 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 aMedi-Cal Managed Care plan for your Medi-Cal benefits. Joining a Medi-Cal ManagedCare 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 PACEcenters and at home. You must qualify for PACE. If you choose PACE, you must still selecta 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 completeand return the choice form by 4/24/2015.MU IA04051 ENG1 0916270IMC010031C-000003-19-7-M-M
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 4/24/2015.After we receive your plan choice, you will receive a letter with your chosen health plan’sname and start date for your coverage. Your new health plan will also send you helpfulinformation about how to get the care you need once you are enrolled. You can changeyour 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 planchoice but it wont be later than 5/1/2015.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 languageor alternative format, please call Health Care Options toll-free at 1-844-580-7272, betweenthe hours of 8:00 a.m. and 5:00 p.m. Monday through Friday. TTY/TDD users please call1-800-430-7077.If you need help completing the choice form, please see the Health Care Optionspresentation schedule inside this choice book for site locations near you or visit us onlineat healthcareoptions.dhcs.ca.gov.If you’d like more information on the specific benefits offered by each health plan, pleasecontact the health plan directly. Health plan contact information is located in the front ofthis 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 helpyou 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.MU IA04051 ENG2 0916
What are my choices?You must choose one of these options. Your choices are listed below. There is nocost to join a health plan.Choice A:Enroll in a Cal Medi-Connect plan. This plan: Combines all of the Medicare and Medi-Calbenefits and services you receive now into asingle plan with added benefits. Gives additional transportation to medicalservices and vision benefits. Gives you a Care Coordinator to helpyou with your health care needs. A CareCoordinator will be assigned to you whenyou join a Cal MediConnect plan. Ensures Cal MediConnect doctors,specialists, and other approved providerswill work together to get you the care youneed.Choice B:Stay with regular Medicare AND enroll ina Medi-Cal Managed Care plan for yourMedi-Cal benefits. If you choose to stay with regularMedicare, you MUST ALSO choose aMedi-Cal Managed Care plan to receiveyour Medi-Cal benefits. If you are already in a Medi-CalManaged Care plan and choose to stayin regular Medicare, you can chooseto stay in that Medi-Cal Managed Careplan or choose a different Medi-CalManaged 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 ManagedCare plan that we have chosen for you.MU 0004071 ENG 0916
How to Make a Health Plan ChoiceThere are several ways you can make a health plan choice.Call Toll Free by 4/30/2015 Health Care Options toll free at 1-844-580-7272, Mondaythrough Friday, 8:00 a.m. to 5:00 p.m. For TTY users, call1-800-430-7077.ORVisit Health Care Options in PersonYou can visit a Health Care Options presentation site and speakto someone in person. To find the nearest location see theenclosed 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 4/24/2015Complete the Health Plan Choice Form in this book and mail inthe postage paid envelope provided.GET MORE INFORMATIONFor free, in-person counseling, contact the Health InsuranceCounseling and Advocacy Program (HICAP). HICAP providesfree and objective information and counseling on healthplans. Call: 1-800-434-0222 or visit: aging.ca.gov/hicapMU 0004070 ENG 0916
Health Plan Choice Form InstructionsThese instructions will help you fill out the Health Plan Choice Form on the next page toselect 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 nameand 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 aMedi-Cal Managed Care plan. Choice A - If you want to get your Medicare and Medi-Cal benefits combined in oneplan, 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 mustchoose a Medi-Cal plan for your Medi-Cal benefits. Fill in the circle ( ) to the left of theMedi-Cal plan you want.If you’d like to get your Medicare and Medi-Cal benefits combined in one plan and receivecare at dedicated PACE centers, fill in the circle for the PACE plan you want. In case you donot 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 meetcertain 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 PACEorganization’s interdisciplinary team assessment and certified by the Department ofHealth Care Services.Ask your doctors and other health care providers to see which plans they work with and checkif your prescription drugs are covered. You may also contact the plans directly to get a list ofdoctors and providers. Telephone numbers for the plans are listed in the front page of thischoice 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 ProviderDirectory located at: Net.aspxSTEP 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 completedHealth Plan Choice Form. Use the envelope in this Choice Book to mail your completedHealth Plan Choice Form. You do not need a stamp if you use the enclosed envelope.MU PCE4062 ENG 0916
Health Plan Choice FormCalifornia Department ofHealth Care ServicesP.O. Box 989009W. Sacramento, CA 95798-9850*CCIPB*Use this form to join or change a health plan. For FREE help with this form, contact Health Care Options at1-844-580-7272. 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.99999USESTEP 1: Tell us about yourself:CCIPBZip CodeDate of BirthJOHN SAMPLE--*M-0-999999999-IMC*Social Security NumberFirst Name, Last NameM-0-999999999-IMCAddress, City( ) - Sex: MaleCIAMonthSTEP 2: Choose your health plan:ORDayCHOICE BKeep my Medicare separate AND choose aMedi-Cal Managed Care plan.Choose one of these Cal MediConnect plans:Choose one of these Medi-Cal Managed Careplans to get your Medi-Cal benefits:FOR304TL.A. CareHealth NetMolina Dual OptionsCare1stOCombine my Medicare and Medi-Cal benefits inone plan.800801816817L.A. Care Health PlanPlan PartnersCFKALABC352Care1st Partner Plan, LLCKP Cal, LLCL.A. Care Health PlanAnthem Blue Cross PartnrshpHealth Net Comm SolutionsNOPlan PartnersHN Health Net Comm SolutionsMO Molina Healthcare PartnerEPLDoctor/Clinic Code:YearFFICHOICE A-If pregnant, estimate due date - - Female(Area Code) Phone Number-L1234 SAMPLE STREET SAMPLE CITYDoctor/Clinic Code:(optional)PACE Plan:052060AltaMed Senior BuenaCareBrandman Cent for Sen CareSAMProgram of the All-Inclusive Care for the Elderly (PACE):You may qualify for PACE (see instructions). If you want to getyour Medicare and Medi-Cal benefits combined in a PACE plan,fill out this option in addition to Choice A or B.(optional)If you do not qualify, you will get your care through theChoice A or Choice B plan that you chose above in Step 2.STEP 3: Read the important information on the back before signing. I understand that by filling out and signing thisform, I am choosing how to get my health care.Applicant’s Signature*CCIPB*CCIPBDateORAuthorized Representative Signature (if any) DateConfidentialMU 0004073 ENG1 0916
Health Plan Choice FormCalifornia Department ofHealth Care ServicesP.O. Box 989009W. Sacramento, CA 95798-9850Read this important information before you sign the form.If I join the Medi-Cal KP Cal, LLC (Kaiser Permanente):I understand that Kaiser requires binding arbitration formy Medi-Cal benefits. This means that I give up my rightto a jury or court trial for medical malpractice and otherdisagreements about benefits and services. Instead,I would help choose independent professionals whowould make a decision about the problem. I can still askfor a Medi-Cal State Hearing.If I choose PACE, I will be contacted to see if I meet theeligibility requirements for enrollment into the PACEhealth plan. I must meet the nursing home level of careand still be able to live safely in a community setting.By completing this enrollment application for a CalMediConnect plan, I agree to the following:Cal MediConnect plans are Medicare-Medicaid plansthat have a contract with the State of California and theFederal government. I will need to keep my MedicareParts A, B and D and Medi-Cal. I can be in only oneMedicare plan at a time, and I understand that myenrollment in the plan selected will automatically endmy enrollment in any other Medicare health plan orMedicare prescription drug plan.I understand that prescription drugs are covered,but not always the same ones I’m already taking. Iunderstand that I’ll be able to receive at least one 30day supply of the prescription drugs I currently takeanytime during the first 90 days of coverage in a CalMediConnect plan. I understand that I may be able tocontinue seeing the doctors I go to now for a periodup to six (6) months for Medicare services and a periodof up to twelve (12) months for Medi-Cal services fromthe effective date of enrollment in a Cal MediConnectplan. I must contact the Cal MediConnect plan forinformation on how to do this. My provider must bewilling to work with my plan and/or accept payment.I further understand that the Cal MediConnect planhas providers and pharmacies that I must use toget health care services, except for non-routine,emergency situations.Cal MediConnect plans serve a specific service area. IfI move out of the area covered by the plan chosen, Ineed to notify the plan so I can disenroll and find a newplan in my new area.I understand that beginning on the date my CalMediConnect coverage begins, I must get all of myhealth care from my new plan, except for emergencyor urgently needed services or out-of-area dialysisservices. Services authorized by my Cal MediConnectplan and other services contained in my plan's Evidenceof Coverage document will be covered. Withoutauthorization, NEITHER Medicare, Medi-Cal NOR my CalMediConnect plan WILL PAY FOR THE SERVICES.Release of Information: By joining this Medicare andMedicaid plan or PACE, I acknowledge that the plan Iselected will release my information to Medicare andother plans as is necessary for treatment, paymentand health care operations. I also acknowledge thatmy Cal MediConnect plan will release my information,including my prescription drug event data, to Medicare,who may release it for research and other purposeswhich follow all applicable Federal statutes andregulations. The information on this enrollment form iscorrect to the best of my knowledge. I understand thatif I intentionally provide false information on this form, Iwill be disenrolled from the plan.I understand that my signature (or the signature ofthe person authorized to act on my behalf under thelaws of California on this application) means that I'veread and understand the contents of this application.If signed by an authorized individual, this signaturecertifies: 1) this person is authorized under State law tocomplete this enrollment and 2) documentation of thisauthority is available upon request from Medicare.Privacy StatementThe 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 andInstitutions 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 seeyour Medi-Cal file, contact the Department of Health Care Services at the address on the other side of this form.MU 0004073 ENG2 0916
Health Information FormYou are receiving this form because you areeligible to enroll in a new Medi-Cal health plan. Yournew plan will use this form to make sure you getneeded care.Please fill in the circle with black or blue penfor the answers that apply to you. Completeone form for each person in your family who isenrolling in a new Medi-Cal health plan.If you have questions, please call Health Care*1010*1010Options, toll free at 1-800-430-4263 Mondaythrough 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 yourMedi-Cal Choice Form or mail separately to:CA Department of Health Care ServicesHealth Care Options - PO Box 989009West Sacramento, CA 95798-9850Filling out this form is voluntary. You will not be denied care based on your confidential Born In: 2016JOHN SAMPLE999999999 - 999999999Name of Person Completing Form:Yes No2. Do you take 3 or more prescription medicines each day?. . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNo3. Do you see a doctor regularly for a mental health condition suchas depression, bipolar disorder, or schizophrenia? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNo4. Have you been to the emergency room two or more times in thelast 12 months? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNo5. Have you been admitted to the hospital in the last 12 months?. . . . . . . . . . . . . . . . . . . . .YesNo6. Have you needed help with personal care, such as bathing, gettingdressed, or changing bandages in the last 6 months? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNo7. Are you using medical equipment or supplies, such as a hospital bed,wheelchair, walker, oxygen, or ostomy bags? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YesNo8. Do you have a condition that limits your activities or what you can do?. . . . . . . . . . . . . . . . .YesNo9. Are you pregnant?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9a. If Yes, are you currently seeing a doctor for this pregnancy? . . . . . . . . . . . . . . . . . . . . . .YesYesNoNo10. Do you see a doctor regularly for a chronic medical condition? . . . . . . . . . . . . . . . . . . . . . . .YesNoIMAMI GESSING1. Do you need to see a doctor within the next 60 days? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If Yes, fill in all that apply:AsthmaCancerCystic FibrosisDiabetesKidney DiseaseSeizuresSickle Cell AnemiaTuberculosisHeart ProblemsHepatitisHigh Blood PressureHIV or AIDSOtherWhen you become a health plan member,If you think you need to see a doctor before yourDHCS will send this information to your Medi-CalMedi-Cal health plan contacts you, you should go tohealth plan.the doctor or hospital at that time.I understand that this information will be disclosed to Health Care Options and my new plan.Signature:Date Signed:If not signed by beneficiary, specify relationship: . Parent of minorCONFIDENTIALGuardian .Other representativeMU 0003754 ENG 0912
State of California - Health and Human Services AgencyDepartment of Health Care ServicesMedi-Cal Managed CareNon-Medical ExemptionRequest for Non-Medical Exemption from Plan EnrollmentAmerican Indians or Beneficiaries with HIV/AIDS in Coordinated Care Initiative CountiesDear Medi-Cal Beneficiary: If you are receiving Medi-Calbenefits, you may be required to join a Medi-Cal ManagedCare health plan. However, if you are a qualified individualfor this exemption and you want to receive medical servicesthrough your choice of facility or provider, you may requestto be excused from Medi-Cal Managed Care health planenrollment in order to receive services through a servicefacility or provider of your choice.To be excused from plan enrollment you must have a servicefacility or provider representative complete this form, certifyingthat you are or will be receiving services from a service facilityor provider of your choice. The facility representative mustsubmit this completed form to Health Care Options.Dear Service Facility or Provider: If you currently provideor will be providing medical services to an individual who isreceiving Medi-Cal benefits and that individual is requiredto enroll in a health plan, completion of this form will enablethe individual to receive services through your facility as analternative to enrollment in a Medi-Cal Managed Care healthplan. The exemption form is valid until the individual choosesto enroll in a Medi-Cal Managed Care health plan. This formmay be submitted for beneficiaries who are receiving Medi-Calservices in a Coordinated Care Initiative County and hasoperating Cal MediConnect health plans and: 1) are AmericanIndian, or 2) have been diagnosed with HIV or AIDS.Mail completed form to:or Fax this form to:Health Care Options(916) 364-0287P.O. Box 989009West Sacramento, CA 95798-9850If 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:2. Beneficiary Medi-Cal I.D. Number (BIC)Last NameFirst NameM.I.3. Name of Service Facility or ProviderI 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 todetermine if the information provided is accurate.4a. Authorized Signature of Medi-Cal Provider4b. Date signed/ /MonthDayYear4d. NPI Number used to bill the Medi-Cal Program for this beneficiary4c. Printed name of Medi-Cal ProviderLast NameFirst Name5. Telephone number of Medical Provider( ) -7. Telephone number of Medical Physician( ) -M.I.6. Fax number of Medical Provider( ) -8. Fax number of Medical Physician( ) -MU CCI3382 ENG 1114
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1OZ 0004074 ENG2 0916Do not put more than 4 forms in this envelope
Health Care OptionsPresentationsAttend an informative session at one of these convenient locations.California Health Care Options (HCO) Presentation SitesLos Angeles CountyOctober 2016 ScheduleJust ask for the"Health Care Options"RepresentativeIn-Person Medi-Cal Managed Care InformationNo Appointment NecessaryFree Help To Complete FormsCITYLOCATIONCounty of LA Dept ofPublic Social ServicesSanta Clarita Branch27233 Camp Plenty RoadCounty of LA Dept ofPublic Social ServicesChatsworth DPSS West Valley FamilyService Center21415 Plummer StreetCanyonCountryComptonCudahyEl MonteCounty of LA Dept ofPublic Social Services211 E. Alondra BoulevardCounty of LA Dept ofPublic Social Services8130 S. Atlantic AvenueCounty of LA Dept ofPublic Social Services SanGabriel Valley FamilyService Center3350 Aerojet AvenueCounty of LA Dept ofPublic Social ServicesSan Gabriel Valley FamilyService Center3352 Aerojet AvenueZIPCODEDAYHCO SITE HOURSLANGUAGES91351M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish91311M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90220M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90201M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishM-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishVietnamese /Cantonese /MandarinM-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish /Vietnamese /Cantonese /Mandarin9173191731Presentation times, dates, and locations are subject to change. Please contact the Health CareOptions toll-free number 1-844-580-7272 to verify the schedule before attending. Additional sites may beavailable at the time of your call. Health Care Options will not be conducting presentations on October10th due to a staff meeting.Page 1 of 4MSM-C-M61LA LTSS PRES ENG1 1016
Health Care OptionsPresentationsAttend an informative session at one of these convenient locations.California Health Care Options (HCO) Presentation SitesLos Angeles CountyOctober 2016 ScheduleJust ask for the"Health Care Options"RepresentativeIn-Person Medi-Cal Managed Care InformationNo Appointment NecessaryFree Help To Complete FormsCITYLOCATIONZIPCODEDAYHCO SITE HOURSLANGUAGESEnglish / Spanish/ Armenian /Russian / FarsiGlendaleLos Angeles County Deptof Public Social Services4680 San Fernando Road91204M-F8:00am - 12:30pm1:30pm - 5:00pmLancasterLos Angeles County Dept of93535Public Social Services349-B East Avenue K-6M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishDept of Public SocialServices County of LosAngeles5445 Whittier Boulevard90022M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishExposition ParkFamily Service CenterCounty of Los Angeles3833 S. Vermont Avenue90037M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90001M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishLos Angeles County Dept of90032Public Social Services4077 N. Mission RoadT&W8:00am - 12:30pm1:30pm - 5:00pmTH8:00am - 12:30pmM-F8:00am - 12:30pm1:30pm - 5:00pmLos Angeles County of LA Dept ofPublic Social Services1740 E. Gage AvenueDept of Public SocialServices County of LA2855 E. Olympic Blvd90023English / SpanishEnglish / SpanishPresentation times, dates, and locations are subject to change. Please contact the Health CareOptions toll-free number 1-844-580-7272 to verify the schedule before attending. Additional sites may beavailable at the time of your call. Health Care Options will not be conducting presentations on October10th due to a staff meeting.Page 2 of 4MSM-C-M61LA LTSS PRES ENG2 1016
Health Care OptionsPresentationsAttend an informative session at one of these convenient locations.California Health Care Options (HCO) Presentation SitesLos Angeles CountyOctober 2016 ScheduleJust ask for the"Health Care Options"RepresentativeIn-Person Medi-Cal Managed Care InformationNo Appointment NecessaryFree Help To Complete FormsCITYZIPCODEDAYHCO SITE HOURSLANGUAGESCounty of Los Angeles2615 S. Grand Avenue90007M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishCounty of LA Dept ofPublic Social Services2601 Wilshire Boulevard90057M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishMetro Special District #702707 S. Grand Avenue90007M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90064M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90059M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishCounty of LAAdministration Building8300 S. Vermont Ave90044M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishCounty of LA Dept ofPublic Social ServicesSouthwest Special District1819 Charlie Sifford Drive90047M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / SpanishLOCATIONDept of Public SocialServices Rancho ParkDistrictLos Angeles 11110 W. Pico BlvdBen F Peery BuildingCounty of LA Dept ofPublic Social Services10728 S. Central AvenuePresentation times, dates, and locations are subject to change. Please contact the Health CareOptions toll-free number 1-844-580-7272 to verify the schedule before attending. Additional sites may beavailable at the time of your call. Health Care Options will not be conducting presentations on October10th due to a staff meeting.Page 3 of 4MSM-C-M61LA LTSS PRES ENG3 1016
Health Care OptionsPresentationsAttend an informative session at one of these convenient locations.California Health Care Options (HCO) Presentation SitesLos Angeles CountyOctober 2016 ScheduleJust ask for the"Health Care Options"RepresentativeIn-Person Medi-Cal Managed Care InformationNo Appointment NecessaryFree Help To Complete FormsCITYLOCATIONDept of Public SocialLos Angeles Services County of LA2415 W. 6th StreetNorwalkPasadenaPomonaRanchoDominguezVan NuysNorwalk12727 Norwalk Blvd.LA County Dept of PublicSocial Services ChildSupport Services955 N. Lake AvenueLA County Dept of PublicSocial Services2040 W. Holt AvenueCounty of LA Dept ofPublic Social ServicesParamount District Office2961 East Victoria StreetZIPCODEDAYHCO SITE HOURSLANGUAGES90057M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish90650M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish91104M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish / Spanish91768M-F8:00am - 12:30pm1:30pm - 5:00pmEnglish /
Choose A Plan See 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 He
