Certain dental services are available through Medi-Cal Dental. For more information regarding dental benefits available in Medi-Cal Dental, or if you need help finding a dentist who accepts Medi-Cal, contact the customer service line at 1-800-322-6384 (TTY users call 1-800-735-2922). The call is free. Medi-Cal Dental representatives are available to assist you from 8:00 a.m. to 5:00 p.m., Monday through Friday. You can also visit the website at smilecalifornia.org/ for more information.

English

• Appointment of Representative – English
• Appointment of Representative – English (Large Print)

Spainish

• Nombramiento de Representante
• Nombramiento de Representante (letra grande)

Complaints (Grievances)

• A written or spoken statement saying that you have a problem or concern about your covered services or care. This includes any concerns about the quality of service, quality of your care, our network providers, or our network pharmacies. The formal name for “making a complaint” is “filing a grievance”.
• If there’s anything else you need to do, Member Services will tell you.
  • You can also write your complaint and send it to us. If you put your complaint in writing, we’ll respond to your complaint in writing.
  • If you are making a complaint because we denied your request for a “fast coverage decision” or a “fast appeal”, we will automatically give you a “fast complaint” and respond within 24 hours.

To make an internal complaint, appeal or coverage decision, call Member Services at 1-866-661-3767 (TTY 711).

• Grievance Form English | Spanish
• Call 1-800-MEDICARE (1-800-633-4227).TTY: 1-877-486-2048
• File with Medicare.gov
• For more information on Complaints, please see the section A. "What do if you have a problem or concern" in the Member Handbook Coverage Decisions (Organization Determinations)
  • A coverage decision is a decision we make about your benefits and coverage or about the amount we pay for your medical services or drugs. You or your doctor can also contact us and ask for a coverage decision. You or your doctor may be unsure whether we cover a specific medical service or if we may refuse to provide medical care you think you need. If you want to know if we’ll cover a medical service before you get it, you can ask us to make a coverage decision for you.

Appeals

• If we make a coverage decision and you aren’t satisfied with this decision, you can “appeal” the decision. An appeal is a formal way of asking us to review and change a coverage decision we made. For more information on Coverage Decisions and Appeals, please see section E. "Coverage Decisions and Appeals" in the Member Handbook

Medicare.gov

• Call 1-800-MEDICARE (1-800-633-4227).TTY: 1-877-486-2048
• File with Medicare.gov

• To learn more about your rights and responsibilities upon disenrollment from Kern Family Health Care Medicare (HMO D-SNP) please review Chapter 8 of the Member Handbook, also called Evidence of Coverage. You can find the Member Handbook by clicking on the link here.
• Para obtener más información sobre sus derechos y responsabilidades al momento de la cancelación de su inscripción de Kern Family Health Care Medicare (HMO D-SNP), consulte el Capítulo 8 del Manual para miembros, también conocido como, Evidencia de Cobertura. Puede encontrar el Manual para miembros dándole clic en el siguiente enlace aquí.

Medicare Disaster and Emergency Policy-PDF

Kern Family Health Care Medicare (HMO D-SNP) Notice of Privacy Practices.

English

Spanish

You may have heard of "extra help" for Medicare members. This program helps with premiums and copays. This program is also called Low Income Subsidy (LIS). Many Medicare members that have low income qualify for LIS. The Centers for Medicare and Medicaid Services (CMS) uses data from state and federal programs to sign up those who qualify for LIS. Sometimes CMS does not get correct or updated data from those sources. To help with this, CMS requires plan sponsors to use a policy known as the Best Available Evidence (BAE) Policy. The BAE Policy is used to help confirm when a member can get LIS.

To learn more about the BAE Policy, click here. When you click this link, you will leave the Kern Family Health Care website

Request for Continuity of Care (COC) - PDF

English

Spanish

Self-Referral Form (Medicare D-SNP) - PDF

English

Spanish