Premera Blue Cross HMO Plan 3000 Core Plus - VMT3000HMO24 - Civil Rights Notice - Language Assistance

Sep 17, 2026

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Premera Blue Cross HMO Plan 3000 Core Plus (certificate form VMT3000HMO24) provides coverage terms subject to the Group contract, explains that state or federal law supersedes any inconsistent provision, and states how the plan’s delegated authority is used for eligibility, benefits, and claims decisions. It includes translation services guidance for verbal language needs. It also presents civil rights and nondiscrimination commitments, lists grievance filing channels, and provides free language assistance instructions for people whose primary language is not English.

LanguageEnglish

CategoryLetters

FormatPDF

Pages129

Reading Time45 min

AccessFree to download

Discrimination is Against the Law

Language Assistance

Translation Services

Premera Blue Cross HMO Plan 3000 Core Plus 100000103 Premera Blue Cross HMO is an Independent Licensee of the Blue Cross Blue Shield Association. The benefits, limitations, exclusions and other coverage provisions in this booklet are subject to the terms of our contract with the Group. This booklet is a part of that contract, which is on file in the Group's office and at Premera Blue Cross HMO. This booklet replaces any other benefit booklet you may have received. The Group has delegated authority to Premera Blue Cross HMO to use its expertise and judgment as part of the routine operation of the plan to reasonably apply the terms of the contract for making decisions as they apply to specific eligibility, benefits and claims situations. This does not prevent you from exercising rights you may have under applicable state or federal law to appeal, have independent review of our judgment and decisions, or bring a civil lawsuit challenging to any eligibility or claims determinations under the contract, including our exercise of our judgment and expertise. If any provision of this Plan is superseded by state or federal law, the Plan will comply with the applicable law as it relates to those provisions. Translation Services If you need an interpreter to help with verbal translation services, please call us. Customer service will be able to guide you through the service. The phone number is available in Contact Information. Group Name: Vigilant Manufacturers’Trust Effective Date: October 1, 2024 Group Number: 100000103 Plan: Core Plus Certificate Form Number: VMT3000HMO24 VMT3000HMO24 Discrimination is Against the Law Premera Blue Cross HMO (Premera HMO) complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation. Premera HMO does not exclude people or treat them differently because of race, color, national origin, age, disability , sex, gender identity, or sexual orientation. Premera HMO provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats) . Premera HMO provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. If you need these services, contact the Civil Rights Coordinator. If you believe that Premera HMO has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation, you can file a grievance with: Civil Rights Coordinator ─ Complaints and Appeals , PO Box 91102 , Seattle, WA 98111 , Toll free: 855-332-4535, Fax: 425-918-5592, TTY: 711, [Email ](Email AppealsDepartmentInquiries@Premera.com. You)[AppealsDepartmentInquiries@Premera.com](Email AppealsDepartmentInquiries@Premera.com. You)[. You](Email AppealsDepartmentInquiries@Premera.com. You) can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at [https://ocrportal.hhs.gov/ocr/portal/lobby.jsf](https://ocrportal.hhs.gov/ocr/portal/lobby.jsf), or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Ave SW, Room 509F, HHH Building, Washington, D.C. 20201, 1-800-368-1019, 800-537-7697 (TDD) . Complaint forms are available at [http://www.hhs.gov/ocr/office/fi](http://www.hhs.gov/ocr/office/fi)le/index. html. You can also file a civil rights complaint with the Washington State Office of the

FAQs

What does “Discrimination is Against the Law” section cover?

It states that Premera Blue Cross HMO complies with federal and Washington state civil rights laws and does not discriminate based on protected characteristics. It also describes free aids and language services to communicate effectively.

How can a grievance or complaint be filed?

A grievance can be filed with the Civil Rights Coordinator for Complaints and Appeals by mail, fax, email, or in person. Civil rights complaints can also be filed with the U.S. Department of Health and Human Services Office for Civil Rights or the Washington State Office of the Insurance Commissioner.

What translation or language assistance services are available?

The document explains that interpreter help is available for verbal translation, with customer service guidance and contact information. It also provides free language assistance instructions for multiple languages and a phone number (TTY: 711).

Sep 17, 2026

Upload by Eden