Directory of Participating Pharmacies STANDARD PHARMACY NETWORK 10/2019 Pharmacies – Statewide California • For all Individual & Family Plans other than CommunityCare HMO and EnhancedCare PPO plans • For Large Group plans, other than Salud HMO, and • For all Small Business Group (SBG) plans, other than SmartCare HMO, Salud HMO (non-grandfathered), CommunityCare HMO, and EnhancedCare PPO plans. Para español, consulte el interior. • • Coverage for every stage of life™ Directorio de Farmacias Participantes RED DE FARMACIAS ESTÁNDAR 10/2019 Farmacias – Todo el Estado California • Para todos los Planes Individuales y Familiares, excepto los planes CommunityCare HMO y EnhancedCare PPO • Para planes de Grandes Empresas, excepto los planes Salud HMO y • Para todos los planes de Pequeñas Empresas (por sus siglas en inglés, SBG), excepto los planes SmartCare HMO, Salud HMO (sin derechos adquiridos), CommunityCare HMO y EnhancedCare PPO. 10/2019 10/2019 10/2019 Table of Contents Introduction..................................................................................................................................7 Pharmacies................................................................................................................................17 I Introduction If you have prescription drug coverage through Health Net of California, Inc. or Health Net Life Insurance Company (Health Net), refer to this list of contracted pharmacies. Pharmacies are grouped by county and city. For more details about your plan benefits and the terms of your coverage, please refer to your Summary of Benefits/Disclosure Form or Evidence of Coverage. You have the right to get full and equal access to health care services covered by your health plan. This is also true if you have a disability, according to the following laws: • The Americans with Disabilities Act of 1990 • Section 504 of the Rehabilitation Act of 1973 Did you find something you think might be wrong in any of our provider directories? Please let us know so we can fix it. • Call our Customer Contact Center at: – 1-800-839-2172 (Individual & Family Plans directly through Health Net) – 1-888-926-4988 (Individual & Family Plans through Covered California™) – 1-800-522-0088 (Small Business and Large Group Plans directly through Health Net) Introduction – 1-888-926-5133 (Small Business Group Plans through Covered California™) • Email us at [email protected]. If you believe you reasonably relied upon materially inaccurate, incomplete, or misleading directory information, you may file a complaint by: 1. Going to https://www.healthnet.com/ContactUs 2. Contacting our Customer Service Department at: • 1-800-839-2172 (Individual & Family Plans directly through Health Net) • 1-888-926-4988 (Individual & Family Plans through Covered California™) • 1-800-522-0088 (Small Business and Large Group Plans directly through Health Net) • 1-888-926-5133 (Small Business Group Plans through Covered California™) 3. Or, by mailing to the following address: Health Net of California, Inc./Health Net Life Insurance Company Appeals & Grievances PO Box 10348 Van Nuys, CA 91410-0348 www.healthnet.com / 7 Introducción Si tiene cobertura de medicamentos que requieren receta médica a través de Health Net of California, Inc. o Health Net Life Insurance Company (Health Net), consulte esta lista de farmacias contratadas. Las farmacias están agrupadas por condado y ciudad. Si desea obtener más detalles sobre los beneficios de su plan y los términos de su cobertura, consulte su Resumen de Beneficios/Formulario de Divulgación o Evidencia de Cobertura. Tiene derecho a obtener un acceso completo e igualitario a los servicios de atención de salud cubiertos por su plan de salud. Esto también es así si usted tiene una discapacidad de acuerdo con las siguientes leyes: • La Ley para los Estadounidenses con Discapacidades de 1990 • Sección 504 de la Ley de Rehabilitación de 1973 ¿Encontró algo que piensa que podría ser incorrecto en alguna parte de nuestro directorio de proveedores? Infórmenos para que podamos corregirlo. • Llame a nuestro Centro de Comunicación con el Cliente al: – 1-800-839-2172 (Planes Individuales y Familiares directamente a través de Health Net) – 1-888-926-4988 (Planes Individuales y Familiares a través de Covered California™) – 1-800-522-0088 (Planes de Pequeñas y Grandes Empresas directamente a través de Health Net) – 1-888-926-5133 (Planes de Pequeñas Empresas a través de Covered California™) • Envíenos un mensaje de correo electrónico a [email protected]. Si considera que usted confió razonablemente en información del directorio sustancialmente inexacta, incompleta o engañosa y desea presentar una queja, puede: 1. Visitar https://www.healthnet.com/ContactUs 2. Comunicarse con nuestro Departamento de Servicios al Cliente al: • 1-800-839-2172 (Planes Individuales y Familiares directamente a través de Health Net) • 1-888-926-4988 (Planes Individuales y Familiares a través de Covered California™) • 1-800-522-0088 (Planes de Pequeñas y Grandes Empresas directamente a través de Health Net) • 1-888-926-5133 (Planes de Pequeñas Empresas a través de Covered California™) 3. O escribir a la siguiente dirección: Health Net of California, Inc./Health Net Life Insurance Company Appeals & Grievances PO Box 10348 Van Nuys, CA 91410-0348 8 / www.healthnet.com Introduction www.healthnet.com / 9 10 / www.healthnet.com www.healthnet.com / FTM037342EH00 Introduction 11 Nondiscrimination Notice In addition to the State of California nondiscrimination requirements (as described in benefit coverage documents), Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) comply with applicable federal civil rights laws and do not discriminate, exclude people or treat them differently on the basis of race, color, national origin, ancestry, religion, marital status, gender, gender identity, sexual orientation, age, disability, or sex. HEALTH NET: • Provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, other formats). • Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact Health Net’s Customer Contact Center at: Individual & Family Plan (IFP) Members On Exchange/Covered California 1-888-926-4988 (TTY: 711) Individual & Family Plan (IFP) Members Off Exchange 1-800-839-2172 (TTY: 711) Individual & Family Plan (IFP) Applicants 1-877-609-8711 (TTY: 711) Group Plans through Health Net 1-800-522-0088 (TTY: 711) If you believe that Health Net has failed to provide these services or discriminated in another way based on one of the characteristics listed above, you can file a grievance by calling Health Net’s Customer Contact Center at the number above and telling them you need help filing a grievance. Health Net’s Customer Contact Center is available to help you file a grievance. You can also file a grievance by mail, fax or email at: Health Net of California, Inc./Health Net Life Insurance Company Appeals & Grievances PO Box 10348, Van Nuys, CA 91410-0348 Fax: 1-877-831-6019 Email: [email protected] (Members) or [email protected] (Applicants) For HMO, HSP, EOA, and POS plans offered through Health Net of California, Inc.: If your health problem is urgent, if you already filed a complaint with Health Net of California, Inc. and are not satisfied with the decision or it has been more than 30 days since you filed a complaint with Health Net of California, Inc., you may submit an Independent Medical Review/ Complaint Form with the Department of Managed Health Care (DMHC). You may submit a complaint form by calling the DMHC Help Desk at 1-888-466-2219 (TDD: 1-877-688-9891) or online at www.dmhc.ca.gov/FileaComplaint. For PPO and EPO plans underwritten by Health Net Life Insurance Company: You may submit a complaint by calling the California Department of Insurance at 1-800-927-4357 or online at https://www.insurance.ca.gov/ 01-consumers/101-help/index.cfm. If you believe you have been discriminated against because of race, color, national origin, age, disability, or sex, you can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), electronically through the OCR Complaint Portal, at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019 (TDD: 1-800-537-7697). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. FLY028964EP00 (3/19) 12 / www.healthnet.com English No Cost Language Services. You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call the Customer Contact Center at the number on your ID card or call Individual & Family Plan (IFP) Off Exchange: 1-800-839-2172 (TTY: 711). For California marketplace, call IFP On Exchange 1-888-926-4988 (TTY: 711) or Small Business 1-888-926-5133 (TTY: 711). For Group Plans through Health Net, call 1-800-522-0088 (TTY: 711). Arabic خدمات لغوية مجانية. يمكننا أن نوفر لك مترجم فوري. ويمكننا أن نقرأ لك الوثائق بلغتك. للحصول على المساعدة الﻻزمة، يرجى التواصل مع مركز خدمة العمﻻء عبر الرقم المبين