CA VERSION • In person: Fill out a Complaint or Benefit Claim/Request form at a member services office located at a Plan Facility (go to your provider directory at kp.org/facilities for addresses) • Online: Use the online form on our website at kp.org You may also contact the Kaiser Permanente Civil Rights Coordinator directly at the addresses below: Attn: Kaiser Permanente Civil Rights Coordinator Member Relations Grievance Operations P.O. Box 939001 San Diego CA 92193 How to file a grievance with the California Department of Health Care Services Office of Civil Rights (For Medi-Cal Beneficiaries Only) You can also file a civil rights complaint with the California Department of Health Care Services Office of Civil Rights in writing, by phone or by email: • By phone: Call DHCS Office of Civil Rights at 916-440-7370 (TTY 711) • By mail: Fill out a complaint form or send a letter to: Deputy Director, Office of Civil Rights Department of Health Care Services Office of Civil Rights P.O. Box 997413, MS 0009 Sacramento, CA 95899-7413 Complaint forms are available at: http://www.dhcs.ca.gov/Pages/Language_Access.aspx • Online: Send an email to [email protected] How to file a grievance with the U.S. Department of Health and Human Services Office of Civil Rights You can file a discrimination complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You can file your complaint in writing, by phone, or online: • By phone: Call 1-800-368-1019 (TTY 711 or 1-800-537-7697) • By mail: Fill out a complaint form or send a letter to: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 Complaint forms are available at: https://www.hhs.gov/ocr/complaints/index.html • Online: Visit the Office of Civil Rights Complaint Portal at: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf.