Common use of Section 1557 Grievance Procedure Clause in Contracts

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • ◼ Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • ◼ A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • ◼ The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • ◼ The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • ◼ You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. grievance.‌ • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. know.‌ • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human ServicesServices , Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • know.‌‌  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: 40XX1984 R01/22 23 Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.. 40XX1984 R01/22 24

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. received.‌‌ The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. grievance.‌ • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • grievance.‌  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human ServicesService s, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton RougeXxx 00000 Xxxxx Xxxxx, LA 70898XX 00000-9012 2250000 000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • know.‌‌  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton RougeXxx 00000 Xxxxx Xxxxx, LA 70898XX 00000-9012 2250000 000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. know.‌ • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. received.‌‌ The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. discrimination.‌‌ Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for lawfor Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. grievance.‌ • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become bec ome aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are proficiencyare provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. complaint.‌‌ The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton RougeXxx 00000 Xxxxx Xxxxx, LA 70898XX 00000-9012 0000 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. received.‌‌ • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-298-7238 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. • Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. • A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. • The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. • The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. • You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.

Section 1557 Grievance Procedure. Blue Cross and Blue Shield of Louisiana does not to discriminate on the basis of race, color, national origin, sex, age or disability. Blue Cross and Blue Shield of Louisiana has adopted an internal grievance procedure providing for prompt resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs and activities. Section 1557 and its implementing regulations may be examined in the office of the Section 1557 Coordinator, who has been designated to coordinate the efforts of Blue Cross and Blue Shield of Louisiana to comply with Section 1557 at the following address: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225000-298000-7238 0000 000-000-0000 (TTY 711) Fax: 000-000-0000 Email: Xxxxxxx0000Xxxxxxxxxxx@xxxxxx.xxx If You believe You have been subjected to discrimination on the basis of race, color, national origin, sex, age or disability disability, You may file a grievance under this procedure. It is against the law for Blue Cross and Blue Shield of Louisiana to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of a grievance. •  Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date You become aware of the alleged discriminatory action. •  A complaint must be in writing, containing Your name and address. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought. •  The Section 1557 Coordinator will investigate the complaint. This investigation may be informal, but it will be thorough. You are encouraged to submit evidence related to Your complaint. The Section 1557 Coordinator will maintain the files and records of Blue Cross and Blue Shield of Louisiana relating to such grievances. To the extent possible, the Section 1557 Coordinator will take appropriate steps to preserve the confidentiality of files and records relating to grievances and will share them only with those who have a need to know. •  The Section 1557 Coordinator will issue a written decision on the grievance no later than 30 days after it is received. •  You may appeal the decision of the Section 1557 Coordinator by writing to the Section 1557 Grievance Administrator within 15 days of receiving the Section 1557 Coordinator’s decision. The Section 1557 Grievance Administrator shall issue a written decision in response to the appeal no later than 30 days after it is received. The availability and use of this grievance procedure does not prevent You from pursuing other legal or administrative remedies, including filing a complaint of discrimination on the basis of race, color, national origin, sex, age or disability in court or with the United States Department of Health and Human Services, Office for Civil Rights. You can file a complaint of discrimination electronically through the Office for Civil Rights Complaint Portal, which is available at: xxxxx://xxxxxxxxx.xxx.xxx/ocr/portal/lobby.jsf, or by mail or phone at: United States Department of Health and Human Services 000 Xxxxxxxxxxxx Xxxxxx, XX Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: xxxx://xxx.xxx.xxx/ocr/office/file/index.html. Such complaints must be filed within 180 days of the date of the alleged discrimination. Blue Cross and Blue Shield of Louisiana will make appropriate arrangements to ensure that individuals with disabilities and individuals with limited English proficiency are provided auxiliary aids and services or language assistance services, respectively, if needed to participate in this grievance process. Such S uch arrangements may include, but are not limited to, providing qualified interpreters, providing taped cassettes of material for individuals with low vision, or assuring a barrier-free location for the proceedings. The Section 1557 Coordinator will be responsible for such arrangements.