medi-cal dental member handbook€¦ · medi-cal dental lub chaw muab kev pab cuam hauv xov tooj:...

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srrille CALIFORNIA! MEDI-CAL HAS DENTAL COVERED

California Department of Health Care Services (Lub Chav Ua Haujlwm ntawm Cov Kev Pab Cuam Saib Xyuas Kev Noj Qab Haus Huv)

2019 Medi-Cal Dental Phau Ntawv Rau Cov Tswv Cuab Fab Kev Kho Hniav Lub Tsib Hlis 2019

Table of Contents

Lus Qhia......................................................................................................................................................................1

Yuav Hu Tau Rau PebLi Cas............................................................................................................................. 3

Kev Pab Txhais Lus..............................................................................................................................................4

Medi-Cal Dental Cov Vevxaij (Websites)................................................................................................... 4

Kev Siv Cov Kev Pab Cuam Kho Hniav Hauv Medi-Cal...................................................................... 5

Medi-Cal Cov Kev Pab Cuam Kho Hniav................................................................................................... 5

Cov Kws Kho Hniav Medi-Cal Dental ...........................................................................................................7

Kev Tau Txais Kev Kho Hniav.......................................................................................................................... 9

Nqi Kho Hniav ........................................................................................................................................................ 11

Kev Thauj Mus Los thiab Lwm Cov Kev Pab ..........................................................................................13

Kev Lis Kev Tsis Txaus Siab.............................................................................................................................15

Tus Txheej Txheem Kev Hais Plaub Ntug Qib Xeev ............................................................................19

Cov Lus Siv Kho Hniav thiab Lwm Cov Lus Txhais............................................................................ 20

Koj Cov Cai thiab Cov Luag Hauj Lwm ....................................................................................................23

Koj Qhov Khoom Ntiag Tug yog Tseem Ceeb rau Peb ....................................................................24

Department of Health Care Services Phau Ntawv Rau Cov Tswv Cuab (Member Handbook)

1 Lub Tsib Hlis 2019

Lus Qhia

Phau ntawv no yuav qhia koj txog koj cov kev pab kho hniav. Peb xav kom koj paub tias qhov kev pab cuam ua hauj lwm zoo li cas thiab koj tuaj yeem tau txais cov kev pab kho hniav li cas. Khaws phau ntawv no cia es koj thiaj tau rov saib dua yog tias koj muaj lus nug tom qab ntawd.

California Qhov Kev Pab Cuam Medi-Cal Dental Medi‑Cal muab cov kev pab cuam pub dawb lossis tus nqi qis rau cov tsim nyog tau txais nyob hauv California suav nrog rau cov kev pab kho hniav. Cov kev pab kho hniav no yog Medi‑Cal muab. Koj yuav tau muab koj daim npav Medi‑Cal Benefts Identifcation Card (Daim Npav Qhia Tus Tau Txais Kev Pab Medi‑Cal, BIC) rau koj tus kws kho hniav thiaj txais tau cov kev pab kho hniav. Koj tsis tas yuav ua ntawv thov Medi‑Cal Dental cais nws muaj nws rau ib qho.

Kev noj qab haus huv ntawm cov hniav los kuj yog ib feem tseem ceeb ntawm tag nrho txoj kev noj qab haus huv. Qhov Kev Pab Cuam Medi‑Cal Dental yuav them rau ntau yam kev pab xwv thiaj ceev tau koj cov hniav kom txhob muaj mob. Koj yuav tau kev pab zoo tshaj lo ntawm koj qhov Medi‑Cal cov kev kho hniav thaum koj:

• Mus ntsib ib tug kws kho hniav nrog Medi‑Cal dental xwv thiaj txais tau cov kev pab uas them rau uas koj xav tau

• Mus ntsib koj tus kws kho hniav Medi‑Cal cuag ncua, tab txawm tias koj cov hniav tsis muaj teeb meem

• Coj raws li koj tus kws kho hniav Medi‑Cal qhia tias yuav ua licas thiaj tu tau cov hniav (xws li kev txhuam thiab dig hniav)

Yog tias koj nyob hauv Lub Sacramento County, yuav muab koj tso npe rau hauv Dental Managed Care (Kev Hwjxwm Kev Kho Hniav, DMC) thiab yuav muab koj tso rau ib tug kws kho hniav nyob hauv koj qhov DMC daim phiaj xwm kho hniav (plan) uas koom hauj lwm ua ke. Yog tias koj nyob hauv Los Angeles County, koj xaiv tau los tso npe nyob hauv DMC lossis nyob twj ywm hauv Medi‑Cal Dental. Yog tias koj tso npe nyob hauv DMC, daim phiaj xwm (plan) koj xaiv yuav xa ib daim npav kho hniav thiab cov ntaub ntawv qhia paub txog koj cov kev pab tuaj rau koj. Nyob rau tag nrho lwm lub counties, koj yuav txais tau kev kho hniav siv koj Medi‑Cal BIC thiab koj xaiv tau koj tus kws kho hniav, yog tias nws tau tso npe rau hauv qhov Kev Pab Cuam Medi‑Cal Dental.

Medi-Cal Daim Npav Qhia Tus Txais Cov Kev Pab Yog Leejtwg Medi‑Cal Dental tsis yog tus txiav txim seb cov tswv cuab puas tsim nyog txais kev pab. Lub County Social Services yog tus uas txiav txim qhov tsim nyog tau txais kev pab hauvqhov Kev Pab Cuam Medi‑Cal Dental thiab lawv muab cov lus qhia no cev rau lub Xeev California. Ces lub Xeev mam li luam tawm ib daim npav Medi‑Cal Benefts Identifcation Card (Daim Npav Qhia Tus Txais Kev Pab Yog Leejtwg, BIC) rau cov tswv cuab uas tsim nyog txais cov kev pab Medi‑Cal. Daim BIC yog daim npav uas siv tau los txheeb xyuas (ID) cov tswv cuab Medi‑Cal. Tiamsis li cas los, qhov uas muaj daim npav tsis yog txhais tias yuav lav tau tias yus tsim nyog txais kev pab Medi‑Cal.

Tsuas yog cov tswv cuab koom California Children’s Services (CCS) xwb thiaj li yuav muaj daim npav BIC uas tus ID muaj 10 tus lej lossis tsiaj ntawv. Dua lwm cov tswv cuab Medi‑Cal tau txais ib daim npav BIC muaj 14 tus lej lossis tsiaj ntawv. Yog tias koj tseem tsis tau txais daim BIC ID muaj 14 tus lej lossis tsiaj ntawv, hu rau koj lub county qhov chaw ua hauj lwm.



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Issue Date 01 01 05

STATE OF CALIFORNIA

TEMPORARY BENEFITS IDENTIFICATION CARD

FOR IDENTIFICATION PURPOSES ONLY PROVIDER : PLEASE VERIFY ELIGIBILITY

ID NO . BICIDNUMBERXXX ISSUE DATE : MM/DD/YYYY GOOD THRU MM/0D/YYYY

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Nram qab no yog cov qauv qhia tias cov tseem npav Medi‑Cal uas siv tau yog licas:

Tus Qauv BIC Poppy: Tus Qauv BIC Ua Ntej Poppy:

Daim Npav Medi‑Cal Txheeb Xyuas Vim Daim Npav Xav Tau Kev Pab Tamsid: Ntseeg Tias Tsim Nyog Txais Kev Pab:

Yuav Siv Phau Ntawv Qhia no li cas Thov nyeem Phau Ntawv Qhia Rau Cov Tswv Cuab no kom tag thiab nyeem kom zoo. Phau ntawv yuav piav tias Medi‑Cal Dental ua hauj lwm licas. Phau ntawv qhia no muaj cov lus qhia tseem ceeb txog ntawm:

• Cov kev pab kho hniav uas Medi‑Cal them rau

• Yuav tau txais kev pab kho hniav li cas

• Yuav tau txais kev pab txhais ua lwm hom lus li cas

• Koj cov cai thiab cov luag hauj lwm

• Yuav ua ntawv tsis txaus siab li cas

• Lwm cov lus qhia tseem ceeb txog cov kev pab kho hniav los ntawm Medi‑Cal

Phau ntawv qhia no siv qee cov ntsiab lus koj tsim nyog paub:

Koj, Kuv, Kuv Qhov, Tus Tswv Cuab

Tus neeg tsim nyog tau txais cov kev pab kho hniav los ntawm Medi‑Cal lossis lawv tus neeg sawv cev uas tau tso cai rau.



Peb, peb, peb li Yog hais txog Medi‑Cal Dental

Koj tus kws kho hniav

Tus kws kho hniav uas koom nrog Medi‑Cal Dental uas koj xaiv rau kev kho hniav rau koj

Thov nyeem ntu hu tias “Cov Lus Siv Kho Hniav thiab Lwm Cov Lus Txhais Tawm”. Nws piav qhia txog ntau cov lus tshwj xeeb uas muaj cov ntsiab lus cov nyom to taub nyuaj hais txog Medi‑Cal Dental.

Yuav Hu Tau Rau PebLi Cas

Lub Chaw Muab Kev Pab Cuam Txais Xov Tooj Telephone Service Center (Lub Chaw Muab Kev Pab Cuam Txais Xov Tooj, TSC) muaj neeg ua hauj lwm nyob ntawd los pab koj hnub Monday txog hnub Friday sij hawm 8:00 a.m. txog 5:00 p.m. Lub TSC yuav muab kaw nyob rau Lub Xeev cov hnub so. Yog tias koj muaj cov lus nug uas tsis tau teb nyob rau hauv phau ntawv no, thov hu rau peb ntawm:

Medi-Cal Dental Lub Chaw Muab Kev Pab Cuam Hauv Xov Tooj:

1-800-322-6384

Sau Ntawv Ntaus Ntawv (TTY):

1-800-735-2922

Tus xov tooj yog hu dawb. TSC cov neeg ua hauj lwm tuaj yeem teb cov lus nug twg uas koj muaj txog ntawm kev mus ntsib tus kws kho hniav. Lawv tuaj yeem pab koj nrog rau:

• Yuav ua licas nrhiav tau ib tug kws kho hniav Medi‑Cal

• Cov lus nug ntsig txog Medi‑Cal Dental

• Kev paub txog ntawm cov kev pab cuam uas tau pom zoo thiab tau tsis kam lees muab

• Kev muaj cov kev pab cuam txhais lus

• Cov lus qhia txog cov nqi thiab cov nqi uas sib faib them (share of cost) thiab cov nqi sib koom nrog them (copayments) thaum txais cov kev pab kho hniav uas kam them rau

• Kev teem sij hawm thiab rov teem sij hawm dua rau ib qho kev ntsib ntsuam xyuas mob

• Cov kev tsis txaus siab thiab cov kev thov kom rov qab txiav txim dua

Kuv tuaj yeem tau txais cov lus qhia dab tsi los ntawm TSC? Thaum koj hu rau lub TSC, nws yuav txuas koj li xov tooj nrog rau ib qho kev txais xov tooj aus taus mas tiv. Koj yuav xaiv los ntawm cov kev xaiv muaj siv (menu).

Koj tuaj yeem tau txais cov lus qhia paub txog:

• Cov kev pab uas them rau



• Yuav xa ib tsab ntawv thov Kev Txiav Txim Plaub Ntug Qib Xeev (State Hearing) li cas

• Yuav thov tau cov qauv luam tawm ntawm koj cov ntaub ntawv kho hniav uas peb muab khaws cia li cas

• Yuav qhia peb paub qhov tau pom tias muaj kev dag Medi‑Cal tsis raws cai li cas

Koj los kuj tseem tuaj yeem tham tau nrog TSC cov neeg ua haujlwm thiab.

Kev Pab Txhais Lus

Yuav ua li cas yog tias kuv xav hais ib hom lus uas tsis yog lus As Kiv? Yog tias koj xav hais ib hom lus uas tsis yog lub As Kiv, hu rau lub TSC. Peb lub TSC cov neeg ua hauj lwm tuaj yeem pab koj tau ua lus As Kiv thiab lus Sab Pees Niv (Spanish). Yog tias koj hais lwm yam lus txawv qhov no, qhia rau cov neeg ua haujlwm rau TSC paub seb koj hais yam lus twg. Peb muaj cov neeg txhais lus uas peb hu tau pab koj.

TSC cov neeg ua hauj lwm los kuj pab tau koj nrhiav kom tau ib tug kws kho hniav Medi‑Cal uas hais koj yam lus lossis muaj cov neeg ua haujlwm hauv lub hoob kas uas hais koj hom lus.

Puas muaj neeg pab txhais lus rau kuv thaum lub sijhawm kuv tham nrog Medi-Cal tus kws kho hniav hauv xov tooj? Muaj Kawg. Yog koj xav tau ib tus neeg txhais lus los sis pab rau cov kev pab cuam txhais lus, hu rau lub TSC. Lawv tuaj yeem pab koj nrhiav ib tus neeg txhais lus.

Puas muaj neeg txhais lus rau kuv thaum nyob ntawm Medi-Cal tus kws kho hniav lub chaw ua haujlwm? Muaj Kawg. Yog tias koj tus kws kho hniav tsis hais koj yam lus, koj muaj cai yuav tau kev pab txhais lus yam tsis tsub nqi rau koj, suav nrog rau ib tug txhais lus piav tes. Tej zaum koj yuav hu rau lub TSC thiab thov ib tus kws txhais lus los pab piav cov ntsiab lus kho hniav rau koj. Qhov no suav nrog rau cov lus uas tus kws kho hniav qhia koj nyob rau thaum koj mus ntsib, xwv thiaj tham tau txog koj daim phiaj xwm (plan) kho hniav, lossis xwv thiaj tau tham nrog cov neeg ua haujlwm kho hniav.

Yog tias koj mus txog ntawm koj qhov chaw teem caij thiab yuav tau muaj ib tug neeg los txhais lus rau koj rau ntawm koj tus kws kho hniav lub chaw ua haujlwm, koj lossis koj tus kws kho hniav yuav hu tau rau lub TSC. Lub TSC yuav pab txuas koj nrog ib tug kws txhais lus uas hais koj yam lus. Tus kws txhais lus yuav nyob twjywm hauv xovtooj tag nrho lub sijhawm uas tau teem cia thiab ntev li qhov koj xav tau. Cov kws txhais lus tsis tuaj rau ntawm qhov chaw kho hniav tiamsis yuav pab koj hauv xovtooj.

Medi-Cal Dental Cov Vevxaij (Websites)

Kuv yuav ua licas thiaj nrhiav tau cov lus qhia ntxog Medi-Cal Dental? Koj yuav nrhiav tau cov lus qhia txog koj cov kev pab Medi‑Cal Dental, cov kev pab uas them rau, thiab ntxiv rau ntawm cov vevxaij Smile, California thiab rau ntawm lub vevxaij Medi‑Cal Dental.

Kuv yuav ua licas thiaj nrhiav tau cov vevxaij rau Smile, California thiab Medi-Cal Dental? Koj yuav nrhiav tau lub vevxaij rau Smile, California rau ntawm SmileCalifornia.org. Koj nrhiav tau lub vevxaij rau Medi‑Cal Dental rau ntawm www.denti‑cal.ca.gov.

http://smilecalifornia.org/

http://www.denti-cal.ca.gov/



Lub vevxaij rau Smile, California ho muaj cov lus qhia twg xwb? Lub vevxaij Smile, California yoojyim siv thiab muaj cov lus qhia txog cov kev pab, suav nrog rau:

• Nrhiav ib tus Kws Kho Hniav • Cov Yeeb Yaj Kiab

• Cov Kev Pab Uas Them Rau • Cov Ntaub Ntawv

• Cov Lus Qhia Ntsig Txog Kev Mus • Cov Ntaub Ntawv Muaj Duab Hu Ua Ntsib Kws Kho Hniav “Fotonovelas”

• Cov Lus Qhia Txog Kev Tu Lub Qhov • Kev Pab Txhais Lus Ncauj Kom Huv

• Tej Yam Ua Si Lom Zem Rau Menyuam • Cov Lus Tshaj Tawm Rau Cov Tswv Yaus

Cuab • Cov Koob Tsheej Uas Teem Cia

• Phau Ntawv Rau Cov Tswv Cuab

Lub vevxaij rau Medi-Cal Dental ho muaj cov lus qhia dab tsi? Lub vevxaij rau Medi‑Cal Dental muaj cov lus qhia tseem ceeb ntau txog ntawm qhov Kev Pab Cuam Medi‑Cal Dental, suav nrog rau:

• Kev ua ntawv thov kom tau Medi‑Cal • Frequently Asked Questions (Cov Lus Nug Nquag Nug, FAQs)

• Qhia Txog Cov Kev Hu Tau Rau • Lwm Cov Kev Paub

• Cov Chaw Kho Hniav • Tshaj Tawm

• Nrhiav ib tus Kws Kho Hniav • Ntawv Nthuav Tawm

• Cov Foos

Koj los kuj yuav nrhiav pom cov lus teb uas feem ntau nquag nug thiab cov nab npawb xov tooj hu dawb rau lub TSC.

Kev Siv Cov Kev Pab Cuam Kho Hniav Hauv Medi-Cal

Kuv yuav nrhiav tau li cas seb kuv puas tuaj yeem tau txais cov kev pab cuam kho hniav? Feem coob cov uas muaj feem tau txais Medi‑Cal los kuj muaj feem txais tau cov kev pab cuam kho hniav. Koj tsis tas yuav ua ntawv thov nws muaj nws kom thiaj tau txais cov kev pab cuam kho hniav. Koj yuav tau muab koj daim npav BIC rau koj tus kws muab kev pab cuam kho hniav thiaj tau txais cov kev pab kho hniav. Yog koj muaj lus nug lossis koj xav saib seb koj puas muaj feem tau txais cov kev pab kho hniav los ntawm Medi‑Cal, hu rau lub TSC.

Medi-Cal Cov Kev Pab Cuam Kho Hniav

Ntu no muaj cov lus qhia txog ntawm kev tu kho hniav uas Medi‑Cal them rau.

Qhov kev pab cuam Medi-Cal muab cov kev pab kho hniav licas? Hauv qab no yog ib cov lus qhia txog cov kev pab uas muab rau cov tswv cuab uas pib siv thaum lub Ib Hlis tim 1, 2018.



• • • • • • • • • • • • • • • • • • • • • • •

• • • •

Cov kev pab no yog muab raws ntawm seb tus lej thaj tsam txais kev pab yog licas thiab tus tswv cuab ho nyob qhov twg. Yuav nrhiav tau cov lus qhia ntxiv nyob rau ntawm lub vevxaij Smile, California rau ntawm SmileCalifornia.org.

COV KEV PAB COV MOS LIAB

COV MENYUAM

COV HLUAS CEV XEEB MENYUAM

COV NEEG MUAJ HNUB

NYOOG

COV HNUB NYOOG

SIAB

Kev Soj Ntsuam* Cov Duab X-ray Kev Ntxuav Tu Hniav Kev Leem Cov Tshuaj Fluoride Tej Ntsaws Hniav Kev rho hniav Cov kev pab xwm txheej kub ceev Kev tso tsuaj kom ib ce muag nthas Tej tshuaj leem tshuaj tiv thaiv rau cov hniav puas** Kev kho cag hniav Kev kho cov hniav uas tuaj tsis ncaj (cov khawb hlau zawm hniav)*** Cov looj cov hniav Cov hniav cuav lo ib sab lossis tag nrho ob sab Kev kho cov hniav lo

Kev ntxuav cov pos hniav kom tob

Tshwj yog: *Cov kev kuaj dawb lossis pheejyig heev txhua rau lub hlis rau cov tswv cuab tsis tau nto 21 xyoos, thiab txhua 12 hlis rau cov tswv cuab muaj 21 xyoos rov saud. **Yuav them rau cov tshuaj leem rau cov hniav puas rau cov menyuam thiab cov hluas tsis tau nto 21 xyoos. ***Rau cov uas tsim nyog tau txais. Mus saib ntu hais txog Cov Ntsiab Lus Kho Hniav thiab Lwm Cov Lus Txhais. Koj tus kws kho hniav yuav qhia koj tias cov kev pab cuam twg yog thiab tsis yog cov uas Medi‑Cal them rau. Koj tus kws kho hniav yuav pab tau koj txiav txim seb qhov kev kho mob twg thiaj zoo tshaj plaws thiab seb yuav txais tau cov kev pab twg los ntawm Medi‑Cal. Nyob rau thaum koj mus ntsib thawj zaug, qhia koj daim npav BIC rau koj tus kws kho hniav xwv lawv thiaj tuaj yeem nkag mus saib tau koj cov kev pab kho hniav.

Puas muaj qhov txwv tias Medi-Cal yuav them npaum licas rau cov kev pab ua them rau hauv ib xyoos? Nws puas sib txawv rau cov menyuam yaus thiab neeg laus? Nws tsis muaj qhov txwv ua xyoo rau me nyuam yaus cov kev pab cuam kho hniav. Qhov ntau tshaj plaws uas Medi‑Cal yuav them rau tej yam kev kho hniav rau cov tswv cuab muaj hnub

http://smilecalifornia.org/



nyoog 21 xyoos rov saud yog $1,800 tauj ib tus neeg tauj ib xyoos, uas muaj ib cov kev txwv. Cov kev peb cuam kho hniav uas yog kev kho uas yuav tau muaj xwb xwb mas tej zaum yuav tso cai rau kom them ntau tshaj $1,800. Nws tsis muaj qhov txwv npaum licas tauj ib xyoos rau cov tswv cuab muaj hnub nyoog 21 xyoos rov saud uas nyob hauv lub tsev laus saib xyuas tu mob.

Nws puas muaj cov kev pab ntxiv rau cov neeg mob uas muaj qhov xav tau tshwj xeeb? Nrog rau ob peb qho kev txwv, qhov them rau cov kev pab cuam kho hniav yog zoo tib yam rau txhuaj leej. Txawm li cas los, cov neeg mob muaj qhov xav tau tshwj xeeb tej zaum lub cev, kev coj cwj pwm, kev loj hlob, los sis cov yam ntxwv kev xav uas txwv rau tus kws kho hniav lub peev xwm los ua qhov ntsuam xyuas tus mob. Thaum muaj li no, yog tus kws kho hniav txiav txim tias tus neeg mob yuav tsum tau ua kom nws ib ce muag nthas tsaug zog thiaj muab kev kho tau nws tus hniav, ces tus kws kho hniav yuav thov kev tso cai los ntawm Medi‑Cal.

Cov kev pab dab tsi muaj rau cov me nyuam yaus? Yog tias koj lossis koj tus menyuam hnub nyoog qis dua 21 xyoos, tej zaum koj muaj cai txais tau cov kev pab cuam ntxiv rau kev kho hniav los ntawm qhov kev pab cuam Early and Periodic Screening, Treatment, and Diagnostic (Kev Tsuaj Xyuas Thaum Ntxov thiab Ua Ntu Zus, Kev Kuaj Kom Pom, thiab Kev Kho, EPSDT). Cov kev pab los ntawm EPSDT muaj cov kev kho uas yuav tau kho xwb xwb xwv thiaj kho tau tus mob lossis ua kom yam kev mob nkeeg zoo dua qub.

Muaj cov kev pab dab tsi rau cov poj niam cev xeeb tub? Yog tias koj cev xeeb tub, txawm koj muaj hom Medi‑Cal hom twg, koj yuav txais tau tag nrho cov kev pab kho hniav yog tias koj muaj raws li tag nrhoMedi‑Cal Dental cov cai rau qhov kev kho ntawd. Cov tswv cuab uas cev xeeb menyuam yuav tsim nyog tau txais cov kev pab no 60 hnub tom qab tau tus me nyuam lawm. Tom qab lawv yug tus me nyuam lawm, lawv muaj cai tau txais kev pab txuas mus ntxiv kom txog rau thaum kawg ntawm lub hlis uas 60 hnub tag.

Cov Kws Kho Hniav Medi-Cal Dental

Koj txais tau kev pab kho hniav los ntawm ib tus kws kho hniav Medi‑Cal twg (ib tug kws kho hniav uas tau rau npe koom Medi‑Cal los muab cov kev kho hniav). Hu rau lub chaw ua hauj lwm kho hniav thiab nug seb lawv puas kam txais Medi‑Cal thiab seb lawv puas kam txais cov neeg tuaj kho hniav tshiab. Thov nyeem ntu no xwv koj thiaj yuav paub tias yuav ua licas thiaj nrhiav tau ib tug kws kho hniav Medi‑Cal uas kho hniav rau Medi‑Cal cov tswv cuab.

Kuv yuav ua licas thiaj nrhiav tau ib tug kws kho hniav Medi-Cal? Koj xaiv tau ib tus kws kho hniav Medi‑Cal twg. Koj hu tau rau lub TSC kom pab nrhiav cov kws kho hniav Medi‑Cal ntawm thaj tsam koj nyob. Yuav nrhiav tau ib tug kws kho hniav Medi‑Cal hauv online uas yog mus saib lub vevxaij Smile, California rau ntawm http://smilecalifornia.org/ fnd‑a‑dentist.

Yuav ua li cas yog tias kuv nrhiav tsis tau ib tug kws kho hniav uas txais Medi-Cal hauv thaj tsam kuv nyob? Yog xav tau kev pab nrhiav cov kws kho hniav Medi‑Cal hauv thaj tsam koj nyob, hu rau lub TSC.

Medi-Cal Dental Lub Chaw Muab Kev Pab Cuam Hauv Xov Tooj:

1-800-322-6384

Sau Ntawv Ntaus Ntawv (TTY):

1-800-735-2922

http://smilecalifornia.org/find-a-dentist/

http://smilecalifornia.org/find-a-dentist/



Yuav ua li cas yog tias kuv xav mus ntsib ib tus kws kho hniav tshwj xeeb? Tej zaum koj tus kws kho hniav Medi‑Cal yuav xa koj mus ntsib dua ib tug kws kho hniav Medi‑Cal xwv thiaj txais tau kev kho tshwjxeeb. Hu tau rau lub TSC kom pab teem koj qhov kev mus ntsib nrog rau tus kws kho hniav tshwjxeeb.

Kuv puas mus tau tom ib lub tsev kho mob me (clinic) rau kuv cov kev pab kho hniav? Tau Kawg. Muaj ntau club tsev kho mob me yuav txais tos Medi‑Cal cov tswv cuab thiab muab cov kev pab kho hniav. Koj txais tau koj cov kev kho hniav nyob hauv lub tsev kho mob me tsuav yog lub tsev kho mob me ntawd tau kev tso cai los txais Medi‑Cal thiab muab cov kev pab kho hniav ua ib feem ntawm lawv cov kev pab cuam lwm yam uas them rau.

Yuav ua licas yog tias kuv ho mus ntsib ib tug kws kho hniav uas tsis tau rau npe koom nrog Medi-Cal Dental? Medi‑Cal Dental qhov kev pab cuam tsuas yog them rau cov kev pab uas koj tau txais los ntawm cov kws kho hniav uas tau tso npe rau hauv qhov Kev Pab Cuam Medi‑Cal Dental. Yog tias koj mus tom ib tug kws kho hniav uas tsis tau tso npe rau hauv qhov Kev Pab Cuam Medi‑Cal Dental, koj yuav tau them cov kev pab cuam kho hniav uas koj tau txais.

Kuv puas hloov pauv tau cov kws kho hniav? Tau Kawg. Koj mus ntsib tau tus kws kho hniav twg uas tau tso npe rau hauv qhov Kev Pab Cuam Medi‑Cal Dental thiab kam txais cov neeg mob tshiab. Yog tias koj tau tso npe nyob rau hauv lub DMC qhov phiaj xwm, koj los kuj tuaj yeem thov kom xa koj mus rau ib tus kws kho hniav uas txawv.

Kuv tuaj yeem hloov pauv tau kuv tus kws kho hniav pes tsawg zaus? Nws tsis muaj qhov txwv rau kev hloov pauv cov kws kho hniav. Txawm li cas los, nws muaj qhov txwv rau kev tau txais cov kev kho uas zoo tib yam nyob rau cov kws kho hniav uas txawv (piv txwv, kev txhuam hniav). Peb xav qhia rau koj tias peb pom zoo rau koj mus xaiv lub tsev kho hniav nrog lub Medi‑Cal tus kws kho hniav.

Kev mus ntsib tib tus kws kho hniav qub yuav pab tau li cas? Kev mus ntsib tib tus kws kho hniav qub rau koj cov kev mus ntsib thiab saib xyuas tas li tuaj yeem muaj txiaj ntsig rau koj nyob rau ntau txoj hauv kev:

• Koj yuav tau txais cov lus ceeb toom rau koj kom nco ntsoov qhov kev mus ntsib zaum tom ntej

• Koj tus kws kho hniav tuaj yeem pab koj nrhiav ib tus kws kho hniav tshwj xeeb yog tias koj qhov kev kho ntawd koj tus kws kho hniav ib txwm kho tsis tuaj yeem kho tau

• Koj tus kws kho hniav yuav paub zoo txog keeb kwm koj kev noj qab haus huv thiab tuaj yeem taw qhia cov teeb meem thaum ntxov yog li ntawd koj tuaj yeem tau txais kev kho ua ntej nws yuav mob loj

Kuv puas yuav hloov pauv tau cov kws kho hniav nyob rau thaum kuv tseem tab tom kho hniav? Yog tias koj cov kev pab cuam kho hniav tau pom zoo lawm rau ib tus kws kho hniav thiab koj xav thov kom hloov koj tus kws kho hniav, koj yuav tau sau ib tsab ntawv thov qhov kev hloov. Muab tsab ntawv rau koj tus kws kho hniav tshiab los mus xa rau Medi‑Cal Dental nrog rau nws qhov kev thov kom tau kev tso cai ua ntej. Medi‑Cal Dental yuav xa tawm ib tsab ntawv pom zoo tshiab rau koj tus kws kho hniav tshiab rau cov kev pab cuam kho hniav uas tseem yuav tau ua kom tiav.



Kev Tau Txais Kev Kho Hniav

Kuv yuav teem caij mus ntsib ib tug kws kho hniav tau licas? Hu rau tus kws kho hniav lub chaw ua haujlwm los mus teem ib lub caij ntsib nws. Qhia rau lawv paub tias Medi‑Cal yuav them rau koj thiab nug seb tus kws kho hniav puas koom nrog Medi‑Cal. Yog koj xav tau kev pab rau kev teem caij, hu rau lub TSC.

Kuv yuav tsum tau nqa dab tsi nrog kuv thaum mus ntsib tus kws kho hniav? Nqa koj daim npav BIC thiab daim ID muaj duab xws li daim ntawv tsav tsheb los sis daim npav ID lub Xeev muab. Nyob rau qhov txheej xwm uas yog cov me nyuam txais los tu (foster children), yog tus leej niam‑txiv txais me nyuam los tu tsis tau txais daim BIC, tus Zauv Social Security tuaj yeem muab siv tau los txheeb seb puas muaj cai tau txais kev pab. Yog koj muaj lwm qhov kev pab them rau kev kho hniav, nqa cov ntaub ntawv ntawd mus qhia rau koj tus kws kho hniav.

Kuv yuav mus ntsib tus kws kho hniav tuab npaum li cas? Kev noj qab haus huv ntawm hniav thiab cov pos hniav yog qhov tseem ceeb ntawm tag nrho txoj kev noj qab haus huv. Koj tus kws kho hniav yuav qhia rau koj tias koj tsim nyog nquag tuaj txais kev ntsuam xyuas tuab npaum li cas ‑ feem ntau kheev yog txhua 6 txog 12 lub hlis. Nyob rau ib feem ntawm koj qhov nquag tuaj ntsuam xyuas hniav, koj tus kws kho hniav yuav tsim ib lub phiaj xwm rau tej qhov kev kho los sis qhov koj yuav tau soj qab rov tuaj ntsib ntxiv. Yog tias koj muaj cov teeb meem txog hniav yam xav tsis txog los sis teeb meem nyob rau ncua koj tau teem caij mus ntsib, hu rau koj tus kws kho hniav lub chaw ua hauj lwm thov kev pab. Hu rau koj tus kws kho hniav tam sim ntawd yog tias koj lub qhov ncauj raug mob los sis mob.

Thaum twg kuv tus me nyuam mos liab tsim nyog mus ntsib kws kho hniav? Koj tus mos liab yuav tsum mus ntsib tus kws kho hniav thaum nws thawj tus kaus hniav pib tuaj los yog nws thawj lub hnub yug, seb qhov twg los ua ntej. Tom qab nws qhov mus ntsib thawj zaug, koj tus me nyuam yuav tau mus ntsuam xyuas hniav txhua rau lub hlis, xam nrog rau cov kev mus tshuaj ntsuam thiab txhuam hniav. Koj yuav nrhiav tau cov lus qhia ntxiv rau ntawm lub vevxaij Smile, California rau ntawm http://smilecalifornia.org/covered‑services/#babies. Medi‑Cal txhawb nqa lub American Association of Pediatrics (Lub Koom Haum Amelikas ntawm Cov Kws Kho Mob Menyuam Yaus) pom zoo kom teem caij rau cov kev pab cuam kho hniav tiv thaiv kom hniav txhob mob, cov uas muab tau rau cov menyuam yaus feem ntau. Cov me nyuam yaus tus uas xav tau kev saib xyuas kev noj qab haus huv tshwj xeeb los sis muaj kab mob los sis raug mob yuav xav tau qhov sib txawv ntawm cov kev pab cuam thiab/los sis lub sij hawm kho. Koj tus me nyuam tus kws kho hniav yuav txiav txim lub sij hawm uas zoo tshaj plaws rau cov kev pab cuam tiv thaiv kom hniav txhob mob rau koj tus me nyuam.

Yuav ua li cas yog thaum kuv muaj xwm txheej ceev? Nyob rau lub sij hawm ua hauj lwm li niaj hnub ua, hu rau koj tus kws kho hniav thiab qhia koj qhov teeb meem. Yog koj tsis tuaj yeem hu tau koj tus kws kho hniav, hu rau lub TSC lub sij hawm 8 a.m txog 5 p.m., hnub Monday txog hnub Friday, kom pab koj tau txais qhov kev pab kho hniav uas koj xav tau. Yog tias koj xav tau kev pab cuam kho hniav xwm txheej kub ceev tom qab cov sijhawm ua haujlwm, koj yuav tau ua raws cov lus qhia nyob ntawm koj tus kws kho hniav tus xovtooj cov lus teb uas qhia rau koj tom qab lub sijhawm ua haujlwm. Mus rau chav xwm txheej kub ceev uas ze tshaj plaws los mus txais cov kev saib xyuas yog tias koj mus pem koj tus kws kho hniav lub chaw ua haujlwm tsis tau lossis yog tias koj tsis muaj ib tug kws kho hniav Medi‑Cal.

http://smilecalifornia.org/covered-services/#babies



Los lus “tsim nyog kho hniav” txhais li cas? Tsim nyog kho hniav yog hais txog lub ntsiab lus muab siv los txiav txim seb puas them rau cov kev pab cuam yog tsim nyog yuav tau kho thiab phim rau qhov kev kho cov kaus hniav, cov pos hniav, thiab kev txhawb lub ncauj hniav raws li cov kws muaj kev paub tshwj xeeb tau paub zoo tus qauv ntawm kev ua hauj lwm. Mus saib ntu muaj Cov Ntsiab Lus Kho Hniav thiab Lwm Cov Lus Txhais kom paub ntxiv.

Yuav zoo li cas yog tias kuv xav tau lub tswv yim pab (opinion) thib ob? Yog tias koj xav tau qhov txheej txheem kev kho hniav uas koj tus kws kho hniav qhia koj tias tsis muaj feem tsim nyog tau txais qhov tsim nyog kho, koj tuaj yeem nug tau lub tswv yim pab thib ob hais txog koj qhov kev kho hniav. Hu rau lub TSC thiab nug thov kev pab los nrhiav ib tus kws kho hniav txawv.

Vim li cas Medi-Cal Dental thiaj hais kom kuv mus ntsuam xyuas kho hniav nrog lwm tus kws kho hniav? Tej zaum koj yuav tau txais ib tsab ntawv “Ceeb Toom Teem Sijhawm Ntsuam Xyuas Kho Hniav” los ntawm Medi‑Cal Dental qhia kom koj mus rau ib qho kev teem caij ntsuam xyuas kho hniav. Thov muab kev koom tes txog qhov ntawd. Qhov kev teem caij tau tsim muaj sawv koj cev los mus txheeb xyuas seb qhov kev thov kho hniav uas koj tus kws kho hniav tau thov puas tau txais kev pom zoo tso cai. Qhov kev teem caij ntsib kws kho hniav no yuav ntev txog li ntawm thaj tsam 15 feeb. Yuav tsis muaj kev ua hauj lwm kho hniav los ntawm tus kws kho hniav ntsuam xyuas no. Koj yuav tsis tau them nyiaj rau qhov kev teem caij ntsib kws kho hniav no. Thaum qhov kev ntsib kws kho hniav no ua tiav tas lawm tus kws kho hniav yuav xa ib daim ntawv qhia rov qab mus rau Medi‑Cal Dental. Daim ntawv qhia paub no yuav muab siv ua lub cuab yeej los mus txiav txim seb cov kev pab cuam puas tsim nyog lees txais los sis tsis kam lees. Yog tias koj tsis tuaj yeem mus tau raws li tau teem tseg, thov hu rau lub TSC yam tsawg kawg ob hnub ua ntej qhov kev teem caij. Yog tias koj tsis mus raws li qhov tau teem caij thiab tsis qhia rau Medi‑Cal Dental paub, tej zaum qhov tau thov cov kev pab cuam yuav raug tsis kam lees muab. Nov yog qee cov lus qhia tseem ceeb los nco cia rau nruab siab:

• Yuav tsum mus kom raws sij hawm rau ntawm qhov tau teem caij rau koj. Yog tias koj mus txog lig, koj qhov kev teem caij ntawd yuav raug rov muab teem dua tshiab.

• Yog tias koj qhov kev teem caij ntsig txog hniav cuav, thiab koj tus kws kho hniav tau thov cov hniav cuav tshiab, nqa cov hniav cuav uas koj tab tom coj tam sim no mus rau qhov chaw teem caij.

• Yog koj hu rau lub TSC, qhia txog “Kev Ntsuam Xyuas #” pom nyob sab hauv qab kawg nkaus ntawm lub ces kaum sab xis ntawm tsab ntawv thaum hu.

• Tus nab npawb xov tooj mus rau ntawm lub chaw ua hauj lwm los kuj muaj nyob hauv tsab ntawv nov los qhia kev nkaus xwb. Hu rau lub TSC yog muaj lus nug ntxiv.

• Tus kws kho hniav uas ntsuam xyuas tsis tuaj yeem tham txog qhov nws pom zoo los sis seb cov kev pab cuam puas tau txais kev pom zoo los yog raug tsis kam lees.

Yuav ua li cas yog kuv xav thim qhov kev teem caij nrog tus kws kho hniav? Yog koj mus tsis tau raws li lub sij hawm tau teem tseg, hu rau tus kws kho hniav lub chaw ua haujlwm yam tsawg kawg yog ib hnub ua ntej lossis hu kom sai li sai tau. Tus kws kho hniav lub chaw ua haujlwm yuav pab koj rov teem koj qhov kev teem caij dua.



Yuav ua li cas yog kuv xav tau cov kev pab cuam kho hniav thaum kuv tawm ntawm California los sis teb chaws? Medi‑Cal muaj cov kws kho hniav nyob hauv lwm lub xeev nyob ze ciam teb ntawm California. Koj txais tau cov kev pab cuam kho hniav uas them rau los ntawm Medi‑Cal cov kws kho hniav no uas nyob rau cov thaj tsam ciam teb xeev no. Kev tso cai ua ntej yuav tau muaj rau tag nrho lwm cov kev pab cuam tawm ntawm lub xeev dhau li ntawm cov xwm txheej kub ceev. Koj tuaj yeem hu rau lub TSC txhawm rau thov kev pab. Cov kev pab cuam uas txais sab nraud lub teb chaws yuav tsis them rau los ntawm Medi‑Cal, tshwj tsis yog cov kev pab cuam xwm txheej kub ceev uas yuav tau mus pw hauv tsev kho mob nyob teb chaws Canada lossis Mexico.

Nqi Kho Hniav

Kuv puas yuav tau them dab tsi rau kuv qhov kev saib xyuas kho hniav? Koj tus kws kho hniav yuav hais tsis tau kom koj them cov kev kho hniav uas Medi‑Cal Dental them rau tsuas yog ntshe koj muaj qhov Medi‑Cal uas koj twb lav nrog sib faib them ib feem (share of cost). Koj yuav nrhiav tau kom paub seb koj tus nqi sib faib them yog licas nyob hauv phau ntawv me “My Medi‑Cal” (Pub. 68) uas koj tau txais nrog koj pob ntaub ntawv tso npe rau Medi‑Cal tshiab. Koj los kuj mus saib tau phau ntawv no nyob rau ntawm: http://www.dhcs. ca.gov/Pages/myMedi‑Cal.aspx.

Tus kws kho hniav tsub nqi rau koj tsis tau rau cov nqi uas them thaum muaj isalas (insurance) los ntawm ib lub tuam txhab xws li cov nqi them ua ntej (deductibles), cov nqi them ib feem nrog (co‑insurance), lossis cov nqi uas sib koom nrog them (copayments) thaum mus kho kiag.

Koj tus kws kho hniav tej zaum yuav tsub nqi rau koj rau cov kev pab kho hniav yog tias koj xaiv mus siv cov kev pab uas tsis them rau los ntawm qhov Kev Pab Cuam Medi‑Cal Dental lossis yog koj muaj 21 xyoos rov saud, thiab xav tau cov kev kho hniav tuaj tsis ncaj (cov khawb hlau zawm hniav).

Sib koom nrog them (copayment) yog dab tsi? Medi‑Cal cov kev pab cuam muaj ib qho nqi sib koom nrog them uas yuav tau them thaum txais kev pab kho kiag. Tus kws kho hniav lub chaw ua hauj lwm yuav sau qhov nyiaj koom nrog them no ntawm koj thaum koj mus ntsib. Saib cov cai txog tus nqi koj yuav tau sib koom nrog them nram qab no.

Medi-Cal Cov Ntsiab Lus Hais Txog Qhov Them Rau Feem Nqi Sib Koom Nrog Them Thaum Mus Ntsib

Cov Kev Pab Cuam Uas Yuav Tau Sib Koom Nrog Them

Nqi Sib Koom Nrog Them

Cov Tsis Xam rau Tus Nqi

Cov Kev Pab Cuam Uas Tsis Yog Xwm Txheej Kub Ceev Uas Tau Muab Nyob Hauv Lub Chav Xwm Txheej Kub Ceev: Ib qho kev pab cuam uas tsis yog xwm txheej kub ceev yog “tej qhov kev pab cuam uas tsis yog ua kom qhov mob loj loj ntaug lossis kev kuaj pom mob tam sid thiab kho cov tsos mob loj uas, yog tias tsis kuaj pom thiab kho sai sai tam sid, yuav ua rau ua tsis taus lossis tuag.”

$5.00 1. Cov neeg muaj hnub nyoog 18 xyoo los sis qis dua.

2. Ib tus poj niam twg uas tau txais kev saib xyuas ncua sij hawm thaum cev xeeb tub thiab ib hlis tom qab yug tus me nyuam tag.

3. Cov neeg twg uas nyob rau lub chaw saib xyuas kev noj qab haus huv (tsev kho mob, lub chaw tu mob muaj kev paub tshwj xeeb, lub chaw muab kev saib xyuas qib nrab).

4. Ib tus me nyuam yaus twg tau txais kev saib xyuas pab tu los ntawm AFDC.

http://www.dhcs.ca.gov/Pages/myMedi-Cal.aspx




Cov kev pab no uas tau muab nyob hauv chav xwm txheej kub ceev yuav tau them tus nqi sib koom nrog them.

5. Ib qho kev pab twg uas qhov kev pab cuam qhov nqi them yog $10 los sis tsawg dua.

Cov Kev Pab Ua Mus Tsev Tib $1.00 1. Cov neeg muaj hnub nyoog 18 xyoo los sis Hnub Ntawd: Kev pab los ntawm qis dua. ib tug kws kho mob, tus kws txiav tsom iav, mob txha nqaj qaum, kev kho sab siab ntsws, kev xyaum hais lus, hnov lus, nkaug koob kho,

2. Ib tus poj niam twg uas tau txais kev saib xyuas ncua sij hawm thaum cev xeeb tub thiab ib hlis tom qab yug tus me nyuam tag.

kev kho kev ua haujlwm, kev kho 3. Cov neeg twg uas nyob rau lub chaw saib menyuam yaus, chaw phais mob, xyuas kev noj qab haus huv (tsev kho mob, tsev kho mob loj lossis tsev kho lub chaw tu mob muaj kev paub tshwj xeeb, mob me uas rov mus tsev tib hnub lub chaw muab kev saib xyuas qib nrab). ntawd, kev kho ua exawsxais, thiab 4. Ib tus me nyuam yaus twg uas tau txais kev kev kho hniav. saib xyuas pab tu los ntawm AFDC

5. Ib qho kev pab twg uas qhov kev pab cuam qhov nqi them yog $10 los sis tsawg dua.

Cov Tshuaj Kws Kho Mob Sau $1.00 Tag nrho cov teev npe saum toj no, ntxiv nrog rau NtawvMus Nqa: Txhua daim tus neeg muaj hnub nyoog 65 xyoo los sis siab ntawv kws kho mob sau yuav dua. tshuaj los sis rov txhab ntxiv.

Yuav ua licas yog tias kuv them tsis tau qhov nyiaj no thaum mus ntsib? Medi‑Cal tus kws kho hniav tsis muaj cai yuav tsis kam ntsib koj yog tias koj them tsis tau tus nqi sib koom nrog them uas koj yuav tau them thaum mus txais kev kho kiag. Qhov no sib txawv ntawm qhov sib faib them (share of cost) ntawm tus nqi.

Kuv yuav ua li cas yog tias kuv tau them rau ib qho kev pab uas kuv tsis tas yuav tsum tau them rau? Hu rau lub TSC kom pab nrog koj hais qhov xwm txheej. Yog tau tsub nqi rau koj them, lossis yog tias koj tau them rau ib qho kev kho hniav uas yog ib qho kev pab ntawm qhov Kev Pab Cuam Medi‑Cal Dental, ces tej zaum yuav pab koj kom ntxiv qhov nyiaj rov qab rau koj. Raws li txoj cai lijchoj hais, Medi‑Cal ib tug kws kho hniav yuav tau them koj qhov nyiaj rov qab rau ib tug nqi thaum koj muab ntawv pov thawj tias Medi‑Cal yeej them rau lub sijhawm uas koj tau txais cov kev kho uas yuav tau kho xwb xwb li.

Yuav ua li cas yog kuv tau ib daim ntawv sau nyiaj los ntawm tus kws kho hniav? Ua ntej tshaj, koj yuav tsum hu rau koj tus kws kho hniav lub chaw ua haujlwm es nug seb yog vim li cas lawv thiaj xa daim ntawv sau nqi rau koj. Lub chaw ua hauj lwm kho hniav yuav qhia qhov tsub nqi thiab vim dab tsi lawv thiaj hais kom koj them. Piv txwv, yog tias koj muaj ib qho ntawm tus nqi sib faib them, koj yuav tau them qhov nqi ntawd ua ntej tus kws kho hniav thov tau Medi‑Cal Dental kom lawv them rau qhov kev kho. Lossis, yog tias koj txais qhov kev kho mob uas Medi‑Cal lossis lwm lub tuam txhab isalas tsis them, koj yuav tau them tus kws kho hniav rau qhov kev kho ntawd. Yog tias koj tseem muaj lus nug dabtsi txog ntawm qhov koj tus kws kho hniav tau tsub tus nqi uas xa rau koj them thiab/lossis qhov twg uas Medi‑Cal Dental them rau, hu rau lub TSC.



Yuav muaj dab tsi tshwm sim yog tias kuv muaj lwm lub tuam txhab tuav pov hwm kho hniav? Koj tus kws kho hniav yuav tau xa daim ntawv sau nyiaj mus rau lwm lub tuam txhab tuav pov hwm kho hniav ua ntej yuav xa rau Medi‑Cal Dental kom them rau ib qhov kev kho mob twg. Qhov Kev Pab Cuam Medi‑Cal Dental yuav tsis them rau cov kev pab twg uas koj txais tau los ntawm lwm lub tuam txhab tuav pov hwm kho hniav suav nrog rau tseemfwv cov kev pab cuam, TRICARE (CHAMPUS) lossis Workers’ Compensation. Medi‑Cal yog qhov thib ob rau tag nrho lwm cov kev kho hniav uas them rau. Yog tias koj muaj lwm qhov tuav pov hwm kho hniav uas tsis kam them rau ib qho kev pab uas Medi‑Cal Dental them, lossis them tsawg dua qhov nyiaj them los ntawm Medi‑Cal Dental, koj tus kws kho hniav yuav xa ib daim ntawv sau nyiaj mus rau Medi‑Cal Dental kom them rau qhov nyiaj tsis tau them. Koj tus kws kho hniav yuav hais tsis tau kom koj them rau cov kev kho hniav uas Medi‑Cal Dental them.

Kev Thauj Mus Los thiab Lwm Cov Kev Pab

Yog tias kuv tsis muaj leejtwg thauj tau kuv, kuv yuav mus tom tus kws kho hniav lub chaw ua haujlwm tau li cas? Medi‑Cal pab tau thauj koj mus los rau cov sijhawm teem cia rau cov kev kho mob, kev noj qab haus huv sab siab ntsws, kev siv yeeb tshuaj yuam kev, lossis cov kev kho hniav uas yog Medi‑Cal them rau. Cov tsheb thauj muaj xws li nonmedical transportation (kev thauj mus los tsis yog kho mob, NMT) los sis non‑emergency medical transportation (kev thauj mus los tsis yog kev kho mob xwm txheej ceev, NEMT). Koj los kuj tuaj yeem siv tau NMT yog tias koj yuav tau mus nqa cov tshuaj kws kho mob sau ntawv mus nqa los sis cuab yeej thiab khoom kho mob. Yog tias koj tuaj yeem mus tau uas yog siv tsheb, tsheb npav, tsheb ciav hlau, los sis tav xij, tab sis tsis muaj qhov caij mus rau koj qhov chaw teem caij, cov kev pab cuam NMT tuaj yeem npaj tau rau koj. Yog tias koj tau tso npe rau hauv Medi‑Cal qhov kev npaj kho mob (plan), hu rau koj qhov kev npaj kho xwv thiaj tau cov lus qhia txog tias yuav mus txais cov kev pab cuam NMT licas. Yog tias koj tsis tau tso npe rau hauv ib qho kev npaj kho (plan) Medi‑Cal, koj ua tau li nram qab no:

• Qhia rau koj tus kws kho mob uas tej zaum yuav pab tau koj nrhiav kom tau kev pab thauj mus los.

• Medi‑Cal yuav muab kev pab thauj mus los uas tau tso cai uas NMT thauj mus los tau. Koj yuav tau hu rau tus muab kev pab thauj uas tau txais kev pom zoo los mus npaj qhov thauj koj, los sis koj tuaj yeem hu rau koj tus kws muab kev pab kho mob los sis kho hniav thiab nug txog ntawm tus muab kev pab thauj mus los nyob rau koj cheeb tsam. Sai sai no yuav muab daim ntawv teev npe cia no tso cia rau ntawm Medi‑Cal nplooj vevxaij txog kev thauj mus los. Mus saib lub DHCS Transportation Homepage.

• Cov tswv cuab lossis cov uas sawv cev rau lawv xa email tau rau DHCS‑Benefts@dhcs. ca.gov mus txog thaum tso cai rau daim ntawv teev npe cov uas tso cai thauj mus los.

Medi‑Cal muab cov kev pab cuam NEMT rau cov tswv cuab uas tsim nyog raws li qhov uas yuav tau kho tus mob xwb xwb, raws li tau txiav txim los ntawm koj tus kws kho mob lossis kws kho hniav, los ntawm qhov kev tso cai ua ntej. Yog koj xav tau ib lub tsheb thauj tshwj xeeb, tsheb kho mob kom mus tau rau tom koj qhov chaw teem caij, qhia rau koj tus kws kho hniav paub. Nws tuaj yeem txib NEMT kom tau xws li lub tsheb tub muaj laub thauj neeg, lub tsheb tub, lub tsheb thauj neeg mob, los sis kev thauj mus los saum huab cua. Rau kev pab thauj mus los, hu lub TSC, los sis hu rau koj tus kws kho mob los sis kws kho hniav los pab koj los sis thov NEMT thauj koj ntawm koj lub tsev mus rau qhov chaw mus ntsib kws kho hniav thiab kho mob. Qhov kev thauj mus los tsuas yog yuav siv tau mus txais cov kev kho mob lossis cov kev pab cuam kho hniav uas Medi‑Cal them rau uas yuav tau muaj xwb xwb.

https://www.dhcs.ca.gov/services/medi-cal/Pages/Transportation.aspx

mailto:[email protected]

mailto:[email protected]



Nco ntsoov nug kom tau tsheb thauj koj kom sai li sai tau li koj tuaj yeem nug tau ua ntej lub sij hawm tau teem caij rau koj. Yog tias koj nquag mus ntsib tsis so, koj tus kws kho hniav los sis kws kho mob tuaj yeem thov ua ntej kom tau tsheb thauj koj mus ntsib lawv rau cov sij hawm uas tau teem cia rau yav tom ntej. Mus saib http://www.dhcs.ca.gov/Pages/myMedi‑Cal.aspx kom paub ntxiv txog kev thauj mus los uas cov NMT tau kev tso cai teem tau.

Yuav ua li cas yog tias kuv hnov lus tsis zoo los sis hais tsis tau lus zoo? Yog tias koj muaj qhov kev tsis hnov lus zoo lossis hais lus nyuaj, hu rau peb hnub Monday txog rau hnub Friday, thaum 8 teev sawv ntxov txog 5 teev tsaus ntuj rau ntawm peb tus xovtooj TTY rau ntawm 1‑800‑855‑7100. Nyob rau tag nrho lwm cov sij hawm, thov hu rau lub California Relay Service TDD/TTY ntawm 711 los mus txais qhov kev pab uas koj xav tau. Cov kev pab cuam American Sign Language (Neeg Mes Kas Lus Piav Tes, ASL) yog muab raws kev cai lij choj. Thaum thov kom tau kev pab ASL, thov npaj yuav qhia tej yam no rau peb:

• Hnub uas tau teem caij kho hniav

• Sij hawm pib thiab sij hawm xaus ntawm qhov mus ntsib kws kho hniav

• Hom kev teem caij (piv txwv: “kev teem caij kho hniav, kev teem caij phais mob, kev sab laj, thiab lwm yam.”)

• Lub npe ntawm tus neeg uas xav tau cov kev pab cuam ASL thiab nws tus ID tswv cuab • Lub chaw ua hauj lwm li chaw nyob thiab nab npawb xov tooj • Lub chaw ua hauj lwm tus neeg hu tau lub npe

Yuav ua li cas yog tias kuv pom kev tsis zoo? Phau ntawv qhia nov thiab lwm cov ntaub ntawv tseem ceeb yuav tau muab luam tawm loj, luam ua tus qauv siv hauv khoos phis tawj kom loj (CD), thiab cuab yeej kaw suab rau tus pom kev tsis zoo. Thov hu rau lub TSC kom tau lwm tus qauv txawv, lossis kom pab nyeem phau ntawv qhia no lossis lwm cov ntaub ntawv Medi‑Cal Dental.

Yuav ua li cas yog kuv muaj ib tus mob los sis lwm qhov teeb meem uas ua rau nws nyuaj rau kuv mus txais kev pab kho hniav? Hu rau lub TSC. TSC cov neeg ua hauj lwm tuaj yeem pab koj nrhiav ib tus kws kho hniav tus uas tuaj yeem kho tau koj. Lawv los kuj tuaj yeem pab khiav hauj lwm nrog koj tus muab kev pab cuam kho mob, yog tias yuav tau ua.

Yuav ua li cas yog kuv lub cev muaj qhov txwv uas ua rau nws nyuaj rau kuv mus ntsib tus kws kho hniav? Peb yuav siv zog ua txhua yam kom paub tseeb tias cov chaw ua haujlwm thiab cov chaw ntawm Medi‑Cal cov kws kho hniav yog cov chaw uas cov neeg lub cev tsis taus mus cuag tau. Yog koj tsis muaj cuab kav nrhiav tau ib qhov chaw kho hniav uas koj mus cuag tau, thov hu rau lub TSC es peb mam pab koj.




Kev Lis Kev Tsis Txaus Siab

Medi‑Cal Dental muaj cov txheej txheem los daws cov kev tsis txaus siab hais txog: • Cov kev pab kho hniav • Kev kho hniav ua tau hauj lwm zoo • Kev hloov kho los sis tsis kam qhov kev thov kev tso cai kho hniav • Lwm fab ntawm cov kev pab uas tau muab nyob hauv qhov Kev Pab Cuam Medi‑Cal Dental

Cov piv txwv ntawm cov kev tsis txaus siab: • Koj tsis tuaj yeem tau txais ib qhov kev pab, kev kho, los sis cov tshuaj raws li koj xav tau • Ib qhov kev pab tau tsis kam lees muab uas hais tias tsis yog ib qhov tsim nyog kho • Koj tau tos ntev heev rau lub sij hawm tau teem caij ntsib kws kho hniav • Koj tau txais kev kho uas phem heev los sis kho yam tsis muaj kev hwm koj • Koj tau raug sau nyiaj nyob ntawm tus kws kho hniav lub chaw ua hauj lwm rau qhov kev

pab uas them rau • Koj tus kws kho hniav lub chaw ua hauj lwm pheej xa ntawv sau nyiaj rau koj uas koj ntseeg

tias koj tsis yog tus them

Kuv yuav ua li cas yog tias Medi-Cal Dental tsis kam lossis txwv qhov kev pab uas kuv tus kws kho hniav tau thov kev tso cai? Yog tias koj tau raug tsis lees muab ib qhov kev pab uas koj tus kws kho hniav tau thov kev pom zoo rau, hu rau koj tus kws kho hniav thiab nug seb tus kws kho hniav puas tuaj yeem thov kom rov ntsuam xyuas dua.

Kuv yuav ua licas nrhiav tau yog hais tias Medi-Cal Dental tau tsis kam lees muab ib qhov kev pab? Yuav xa ib tsab ntawv Ceeb Toom Ntawm Denti‑Cal Kev Txiav Txim tuaj rau koj yog tias tsis kam muab koj qhov kev kho hniav lossis muab hloov kho. Tsab ntawv ceeb toom no yuav qhia tias yog vim li cas qhov tau thov kev kho hniav thiaj raug tsis lees muab los sis tau muab hloov kho. Tsab ntawv ceeb toom tsem yuav qhia paub txog ntawm koj yuav ua tau li cas yog tias koj tsis pom zoo nrog qhov tau txiav txim ua ntawd.

Kuv yuav ua li cas yog tias kuv muaj qhov tsis txaus siab? Kuv yuav xa qhov tsis txaus siab raws cai tau li cas? Qee cov kev tsis txaus siab tuaj yeem muab daws tau yam sai los ntawm kev tham ua ntej nrog koj tus kws kho hniav txog ntawm qhov teeb meem. Feem ntau, tus kws kho hniav tuaj yeem daws tau qhov koj tsis txaus siab yam sai heev. Yog tias koj tsis xav tham nrog koj tus kws kho hniav ua ntej los sis yog tias tus kws kho hniav tsis muaj peev xwm daws koj qhov tsis txaus siab, hu rau lub TSC. Yuav hu xovtooj lossis sau ntawv tau rau Medi‑Cal Dental mus qhia cov kev tsis txaus siab.

Thaum koj hu rau lub TSC, qhia lawv paub txog ntawm koj thiab lub npe ntawm tus kws kho hniav uas tau cuam tshuam rau qhov koj tsis txaus siab. Qhia koj qhov teeb meem, nrog rau cov kev pab uas cuam tshuam rau qhov koj tsis txaus siab thiab tej cov kev coj ua los sis tsis tau ua dab tsi li. Lub TSC yuav ua txhua yam los mus daws qhov teeb meem thaum lub sij hawm hu xov tooj. Koj yuav tau txais xov tooj hu raws qab tuaj yog tias koj qhov kev tsis txaus siab tseem tsis tau raug daws los ntawm lub TSC nyob rau thaum hu xov tooj thawj zaug.



Medi-Cal Dental Lub Chaw Muab Kev Pab Cuam Hauv Xovtooj:

1-800-322-6384

Sau Ntawv Ntau Ntawv (TTY):

1-800-735-2922

Yog tias koj xaiv qhov sau ua ib tsab ntawv, koj mus theej tawm tau Medi‑Cal Dental Kev Tsis Txaus Siab ib daim ntawv foos los ntawm Medi‑Cal Dental lub vevxaij. Ua kom tiav thiab xa daim ntawv foos no rov qab mus rau Medi‑Cal Dental ntawm qhov chaw uas muab sau cia nyob rau ntawm daim ntawv foos. Medi‑Cal Dental yuav qhia rau koj paub tias tau txais koj daim ntawv foos tsis pub dhau tsib hnub suav txij hnub tau txais. Koj los kuj tuaj yeem hu tau rau TSC mus nug seb lawv puas tau txais koj daim ntawv foos.

Ib qho piv txwv ntawm Medi‑Cal Dental Daim Ntawv Foos Tsis Txaus Siab muaj nyob rau ntawm nplooj ntawv tom ntej. Koj kuj nrhiav tau daim ntawv foos no nyob rau ntawm Medi‑Cal Dental lub vavxaij nplooj rau cov tswv cuab nyob ntawm: https://www.denti‑cal.ca.gov/ Benefciaries/Denti‑Cal/Benefciary_Forms/. Daim ntawv foos no tsuas muaj ua lus Askiv nrog rau kev pab txhais tawm ua 16 yam lus uas muaj neeg coob txaus yuav siv.

Lub Department of Health Care Services coj raws li Tsoom Fwv txhua cov cai lij choj hais txog pej xeem cov cai thiab yuav tsis muaj kev ntxub ntxaug leej twg vim los ntawm nws haiv neeg, tsos nqaij daim tawv, keeb kwm teb chaws uas nws yug, hnub nyoog, kev xiam oob qhab, los sis qhov yog poj niam‑txiv neej. Lub Department of Health Care Services yuav tsis cais tawm los sis muab kev pab kho lawv txawv lwm tus vim yog ntawm lawv haiv neeg, tsos nqaij daim tawv, keeb kwm teb chaws uas nws yug, hnub nyoog, kev xiam oob qhab, los sis qhov yog poj niam‑txiv neej. Yog xav paub ntxiv txog ntawm tsab cai tsis pub muaj kev ntxub ntxaug, thov mus saib Department of Health Care Services lub vevxaij ntawm: http://www.dhcs.ca.gov/ Pages/Language_Access.aspx.

https://www.denti-cal.ca.gov/Beneficiaries/Denti-Cal/Beneficiary_Forms/


http://www.dhcs.ca.gov/Pages/Language_Access.aspx




W~HCS I Medi-Cal Dental

-

DATE: NAME: ADDRESS: CITY: ST: ZIP:

MEDI-CAL DENTAL COMPLAINT FORM

Please fill in the form below and describe your questions or complaints completely. This information is important and necessary to research and resolve your questions or complaints.

STATE OF CALIFORNIA MEDI-CAL BENEFITS IDENTIFICATION CARD NUMBER:

TELEPHONE NUMBER: ( )

MESSAGE TELEPHONE NUMBER: ( )

YOUR REPRESENTATIVE (if not yourself):

NAME:

ADDRESS:

CITY: , STATE: ZIP CODE:


YOUR DENTAL PROVIDER’S NAME:

NAME:

ADDRESS:

CITY: , STATE: ZIP CODE:


P.O Box 15539 Sacramento, CA 95852-0609 (800) 322-6384



~HCS I Medi-Cal Dental

MEDI-CAL DENTAL COMPLAINT FORM (PAGE 2)

TYPE OF COMPLAINT:

Dentist service was incomplete or unsatisfactory

Clinical Screening process was unsatisfactory

Other

Comments (Please describe your questions or complaints/ grievances completelyhere. Use the reverse side of this form or additional pages if you need additionalspace.)

PLEASE SIGN AND DATE THIS FORM:

It may be necessary to obtain your medical records from your dental care provider. Your signature below authorizes release of your dental records to Medi-Cal Dental.

SIGNATURE DATE

Return this form to: Medi-Cal Dental Program Member Services Group P.O. Box 15539 Sacramento, CA 95852-1539

When we receive this information, we will research your questions or complaints/grievances and notify you of our findings. If it is necessary for you to appear for a clinical examination in order to resolve this matter, we will notify you in writing of the date, time, and location of this appointment.

P.O Box 15539 Sacramento, CA 95852-0609 (800) 322-6384



Muaj dab tsi tshwm sim tom qab kuv xa daim ntawv tsis txaus siab? Yog tias koj hais txog qhov koj tsis txaus siab hauv lub xov tooj thiab qhov tsis txaus siab ntawd muab daws tsis tau nyob rau thaum hu xov tooj, koj yuav tau txais ib tsab xov tooj raws qab los muab kev pab ntxiv lawm tom ntej. Yog tias tseem daws tsis tau qhov koj tsis txaus siab hauv xov tooj uas hu tuaj raws qab ntxiv no thiab, ces peb yuav pab koj theej tawm Medi‑Cal Dental Daim Ntawv Foos Tsis Txaus Siab (Medi‑Cal Dental Complaint Form) los ntawm Medi‑Cal Dental lub vevxaij https://www.denti‑cal.ca.gov/Benefciaries/Denti‑Cal/Benefciary_Forms/. Peb tseem tuaj yeem xa tau daim foos hauv tsev xa ntawv tuaj rau koj thiab. Thaum koj sau tag thiab tau kos npe rau daim ntawv foos lawm, xa nws mus rau Medi‑Cal Dental rau ntawm qhov chaw nyob uas muab sau cia rau ntawm daim ntawv foos. Saum toj no yuav pom muaj daim ntawv foos tsis txaus siab (Complaint Form) ua qauv qhia. Yog koj tau xa ib daim ntawv foos tsis txaus siab, Medi‑Cal Dental yuav qhia rau koj paub tias lawv tau txais daim ntawv foos lawm tsis pub dhau tsib hnub suav txij hnub tau txais koj Daim Ntawv Foos Tsis Txaus Siab (Complaint Form). Tej zaum yuav xa daim ntawv foos tsis txaus siab mus rau Medi‑Cal ib tus kws pab tswv yim kho hniav, tus uas yuav los txiav txim seb yuav ua licas txuas ntxiv mus. Tej zaum peb yuav:

• Hu rau koj thiab/los sis tus kws kho hniav • Xa koj mus rau qhov kev ntsuam xyuas kho mob • Xa mus rau tus neeg nrog xyuas uas phim rau qhov no

Medi‑Cal Dental yuav xa ib tsab ntawv sau lub ntsiab lus ntawm cov kev tshawb tau thiab yog vim li cas thiaj txiav txim mus li ntawd tsis pub dhau 30 hnub suav txij hnub txais tau daim ntawv foos tsis txaus siab. Cov kev tsis txaus siab feem ntau yeej muab daws tau tsis tau dhau 30 hnub; tiamsis, tej zaum yuav siv ntev tshaj 30 hnub rau tej tug. Piv txwv, tej zaum koj yuav xav tau sij hawm ntxiv los mus koom koj qhov kev teem caij ntsuam xyuas kho mob.

Yog tias kuv tsis nyiam qhov tshwm sim thaum kuv xa daim ntawv tsis txaus siab, puas tshuav dab tsi ntxiv uas kuv tuaj yeem ua tau? Yog tias koj tseem tsis txaus siab rau qhov kev txiav txim txog qhov koj tsis txaus siab, thov hu rau lub TSC. Tej zaum yuav thov kom koj tus kws kho mob xa ib daim ntawv Thov Kev Tso Cai Rau Kev Kho (Treatment Authorization Request) thiab kom koj rov mus tshuaj xyuas dua. Koj yuav thov tau kom tsa ib lub rooj tham kev tsis txaus siab nrog lub xeev (state hearing) yog tias koj tseem tsis txaus siab. Yog xav paub ntxiv txog Medi‑Cal Kev Hais Plaub Qib Xeev, thov mus saib ntawm Department of Health Care Services lub vevxaij ntawm: http://www.dhcs.ca.gov/ services/medi‑cal/Pages/Medi‑CalFairHearing.aspx.

Tus Txheej Txheem Kev Hais Plaub Ntug Qib Xeev Yog tias qhov kev kho uas koj tus kws kho hniav tau thov raug tsis kam lees muab lossis tau muab hloov kho, lossis koj tsis txaus siab rau qhov kev daws teebmeem ntawm koj ib qho kev pab uas tsis kam lees muab, koj yuav thov tau tus kom tsa Rooj Hais Kev Tsis Txaus Siab Ntawm Qib Xeev los ntawm lub California Department of Social Services (CDSS). Koj lub county lub chaw ua hauj lwm hauv zos (social services ofce) tuaj yeem pab koj nrog rau qhov kev thov nov. Koj nrhiav tau tus lej xov tooj muaj teev tseg nyob hauv phau ntawv teev cov lej xovtooj hauv koj zos, koj lub county lub vevxaij, lossis yog siv Medi‑Cal lub app hauv xov tooj ntawm tes. Koj tuaj yeem sawv cev rau koj tus kheej nyob rau ntawm Qhov Chaw Hais Plaub Qib Xeev, los sis ib tus phooj ywg, kws lij choj, los sis lwm tus neeg tuaj yeem sawv cev tau rau koj. Koj yog tus yuav tau ua lub luag hauj lwm los npaj yog tias koj xav kom lwm tus sawv cev rau koj. Yog xav tau kev pab pub dawb rau fab kev hais plaub raws cai, hu rau lub Public Inquiry and Response Unit ntawm CDSS ntawm 1‑800‑952‑5253. Lub chaw nov los kuj tuaj yeem pab qhia kom paub txog kev lis dej num tus txheej txheem ntawm lub Chaw Hais Plaub Ntug Qib Xeev.


http://www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFairHearing.aspx


http://www.dhcs.ca.gov/med50th/Pages/Medi-Cal_App.aspx



Kev thov rau qho hais plaub ntug qib xeev yuav tsis cuam tshuam koj qhov muaj feem tau txais kev pab cuam kho hniav thiab koj yuav tsis raug rau txim raug nplua li cas rau ntawm qhov tau thov kom muaj qhov kev hais plaub (hearing) no. Peb yuav tuav tswj kom tsis pub leej twg paub nyob rau ncua sij hawm muaj qhov kev sib hais tsis txaus siab.

Thaum twg kuv yuav thov tau ib lub rooj Hais Plaub Ntug Qib Xeev (State Hearing)? Yog tias koj tsis pom zoo raws li Denti‑Cal Notice of Action (Denti‑Cal Tsab Ntawv Ceeb Toom ntawm Kev Txiav Txim) uas koj tau txais, ua ntej tshaj plaws koj yuav tsum nrog koj tus kws kho hniav tham txog tag nrho lwm cov kev kho kom tau txais qhov kev kho uas zoo tshaj plaws rau koj uas qhov Kev Pab Cuam Medi‑Cal Dental them rau. Yog tias koj thiab koj tus kws kho hniav pom zoo tias qhov phiaj xwm kho uas txawv ntawd tsis yog txoj hauv kev, koj muaj 90 hnub tom qab hnub tim nyob rau tsab ntawv ceeb toom ntawd los mus thov ib lub rooj Hais Plaub Ntug Qib Xeev.

Kuv yuav pib lis qhov dej num no li cas? Koj tuaj yeem pib lis qhov dej num los ntawm kev hu rau tus npawb xov tooj hu dawb 1‑800‑952‑5253. Tej zaum koj yuav xa tau tsab ntawv Notice of Denti‑Cal Action tas nrho los sis sau rau:

California Department of Social Services State Hearings Division P.O. Box 944243 MS 9‑17‑37 Sacramento, CA 94244‑2430

Yog tias koj hu xov tooj los sis sau ntawv mus thov kom tsa muaj lub rooj Hais Plaub Ntug Qib Xeev, nco ntsoov sau tus Document Control Number (Nab Npawb Tuav Tswj Ntaub Ntawv, DCN), nyob rau ntawm Tsab Ntawv Ceeb Toom ntawm Denti‑Cal Kev Txiav Txim (Notice of Denti‑Cal Action). Tus DCN qhia paub txog qhov Thov Rau Kev Tso Cai Kho Mob (Treatment Authorization Request) uas cov kev pab tau raug tsis kam lees muab thiab pab kom txoj kev lis koj daim ntawv thov mus ceev.

Cov Lus Siv Kho Hniav thiab Lwm Cov Lus Txhais Muaj cov lus ntau uas muab siv hauv qhov Kev Pab Cuam Medi‑Cal Dental uas muaj lub ntsiab lus tshwj xeeb lossis to taub nyuaj. Thiab, qee cov ntsiab lus kho hniav yuav tsis zoo sib thooj thiab ua rau yus paub tsis zoo. Peb vam tias koj yuav nrhiav tau cov ntsiab lus txhais hauv qab no pab tau koj zoo. Yog koj muaj lus nug, thov hu rau lub TSC thiab nrog ib tus ntawm peb cov neeg sawv cev tham. Tus Lej Cim Muab Kev Pab: Qhia txog hom Medi‑Cal pab them rau uas koj muaj. Thov Kom Rov Qab Txiav Txim Dua: Yog ib qho kev thov raws cai kom Medi‑Cal Dental rov los tshuaj xyuas cov kev pab cuam uas tsis kam them rau ib qho kev kho mob uas tau muab. Tsab ntawv thov kom rov qab txiav txim dua tej zaum yuav ua los ntawm koj tus kws kho hniav, koj tus kheej, los sis ib tus sawv cev uas tau kev tso cai. Kev Tso Cai: Saib Kev Tso Cai Ua Ntej. Tus Tau Txais Kev Pab: Tus neeg uas tsim nyog tau txais kev pab Medi‑Cal. Benefciary Identifcation Card (Daim Npav Qhia Txog Tus Txais Kev Pab, BIC): Daim npav qhia txog tus kheej yog muab rau cov tswv cuab uas txais kev pab los ntawm lub Chav Ua Haujlwm Pab Cuam Saib Xyuas Kev Noj Qab Haus Huv (Department of Health Care Services). Daim npav BIC muaj tus lej tswv cuab thiab lwm cov lus qhia tseem ceeb. Cov Kev Pab: Cov kev pab cuam kho hniav uas yuav tau muaj xwb xwb los ntawm Medi‑Cal ib tug kws kho hniav uas muaj nyob hauv qhov Kev Pab Cuam Medi‑Cal Dental.



Kev Ntsuam Xyuas Kho: Ib qho kev ntsuam xyuas los ntawm ib tug kws kho hniav uas yuav qhia tias nws pom licas txog qhov yuav muab kev kho tus hniav los yog muab qhov kev kho los ntawm lwm tus kws kho hniav ntawm Medi‑Cal. Tej zaum yuav muaj tej lub sijhawm uas qhov Kev Pab Cuam Medi‑Cal Dental yuav kom ua ib qho kev ntsuam xyuas li no. Kev Tsis Txaus Siab: Ib qhov tsis txaus siab uas cia li hais ntawm ncauj lossis sau ntawv qhia, uas muaj xws li kev sib hais tsis haum, kev thov kom rov qab txiav txim dua, lossis kev thov kom rov xyuas dua uas yog hais los ntawm ib tus tswv cuab, lossis ib tus kws kho hniav hais sawv cevtus neeg tau txais kev pab. Feem ntau qhov hais los yog ua ntawv tsis txaus siab no kheev yog vim los ntawm cov teeb meem ntawm txoj hauj lwm los yog cov neeg ua hauj lwm uas muab qhov kev pab. Tus Nqi Sib Koom Nrog Them (Copayment) Thaum Txais Kev Pab Kiag: Ib qho me nyiaj ntawm tus nqi them rau tus kws kho hniav uas tus tswv cuab them. Cov Kev Pab Uas Them Rau: Cov kev kho hniav uas yog cov kev pab ntawm Medi‑Cal Dental. Medi‑Cal Dental tsuas yog them rau cov kev pab cuam kho hniav uas yuav tau muaj xwb uas yog muab los ntawm ib tug kws kho hniav uas yog ib feem ntawm qhov Kev Pab Cuam Medi‑Cal Dental. Cov me nyuam yaus hnub nyoog qis dua 21 xyoos muaj cai tau txais cov kev pab uas them rau ntau dua, xws li txoj khawb hlau tuav hniav, yog tias tsim nyog yuav tsum tauv kho qhov mob. Tus Kws Kho Hniav Tshwjxeeb: Ib tus kws kho hniav uas muab cov kev kho tshwj xeeb xws li tshau kaus hniav, phais qhov ncauj, txhuam hniav rau me nyuam yaus, tu ib ncig kaus hniav, thiab zawm hniav kom ncaj (khawb tuav hniav). Kev Ntsuam Xyuas Thaum Ntxov thiab Ua Ntu Zus, Kev Kuaj Pom Mob thiab Kev Kho (EPSDT): EPSDT cia cov menyuam thiab cov hluas uas tsis tau nto 21 xyoos uas rau npe nrog Medi‑Cal tau txais cov kev pab kho hniav tiv thaiv mob (kev tshuaj xyuas) thiab kev pab kuaj thiab kho uas yuav tau muaj xwb xwb xwv thiaj pab kho tau cov kev mob nkeeg kom yog thiab kom zoo dua tuaj. Tsim Nyog Tau Txais: Hais txog seb puas muaj raws li cov cai los mus txais tau cov kev pab Medi‑Cal. Tus Mob Hniav Xwm Txheej Kub Ceev: Ib tus mob hniav uas yog tias tsis tau txais kev kho tam sim ntawd yam muaj laj thawj yuav tuaj yeem tshwm sim ua rau muab tus neeg ntawd txoj kev noj qab haus huv tso rau qhov muaj kev phom sij, ua rau muaj mob loj los sis tsis ua hauj lwm. Tus Kws Kho Cag Hniav: Ib tus kws kho hniav tshwj xeeb uas muaj qhov txwv kev ua hauj lwm kho kab mob thiab cov kev raug mob ntawm tus hlwb hniav thiab cag hniav. Kev Pab Medi‑Cal Txhua Fab: Kev Pab Medi‑Cal txhua Fab muab cov kev pab kho mob rau cov uas khwv tau nyiaj tsawg los. Tag nrho cov menyuam yaus uas tso npe rau hauv Medi‑Cal, cov menyuam yaus nyob rau kev coj los tu saib xyuas ib ntus (foster care) thiab cov hluas hnub nyoog mus txog rau 26 xyoo uas yav tas los luag tau coj los tu ib ntus, cov poj niam cev xeeb tub, thiab cov dig muag lossis cov neeg ua tsis taus yuav tau txais qhov kev pab no. Kev Qhia Txog Tus Kheej: Hais txog tej yam uas qhia tias tus neeg ntawd yog leej twg, xws li daim ntawv tsav tsheb. Cov Kev Txwv: Hais txog tus naj npawb qhov ntau ntawm cov kev pab cuam tau tso cai, hom kev pab cuam tau tso cai, thiab/los sis qhov kev kho hniav uas lees txais tau uas phim tshaj plaws. Medi‑Cal Dental: Qhov kev pab cuam Medi‑Cal kho hniav uas yog pab them raws li tus naj npawb muab kev kho (fee‑for‑service).



Kev Kho Uas Yuav Tsum Tau Txais Xwb Xwb: Cov kev pab kho uas yuav tsum tau muab xwb xwb thiab phim rau cov kev kho hniav, pos hniav, thiab ib puag ncig txhawb tus hniav thiab yog (a) tau muab raws li cov qauv kev ua hauj lwm tau pom tias muaj kev paub tshwj xeeb; (b) tau txiav txim los ntawm tus kws kho hniav uas haum raws li tus tsos mob hniav; thiab (c) yog hom uas phim tshaj plaws, muab thiab qib ntawm kev pab cuam uas saib raws li cov kev phom sij uas yuav tshwm sim, cov kev pab, thiab cov kev pab uas them rau qhov uas yog cov hauv kev xaiv. Lwm Qhov Kev Pab Them Tus Nqi Rau Kev Noj Qab Haus Huv / Lwm Qhov Tuav Pov Hwm Kho Mob (Health Insurance): Cov kev pab them rau cov kev kho hniav uas koj muaj nyob hauv kev kho hniav ntiav uas tsis yog tsoom fwv li (private plan), tej lub teeb txheem tuav pov hwv twg (insurance program), tej lub teeb txheem ntawm lub Xeev los sis tsoom fwv kev pab cuam kho hniav, los sis nyob rau hauv lwm qhov kev cog lus los sis muaj cai raws kev cai lij choj. Tus Kws Phais Qhov Ncauj: Ib tus kws kho hniav tshwj xeeb uas muaj qhov txwv kev ua hauj lwm los mus tshawb pom qhov mob thiab phais kho cov kab mob, cov kev raug mob, cov tsis zoo li ib txwm muaj los, cov tsis zoo thiab qhov saib pom ntawm qhov ncauj, kauj tsaim thiab ntsej muag. Tus Kws Kho Hniav Uas Tuaj Tsis Ncaj: Ib tus kws kho hniav tshwj xeeb uas ua hauj lwm los mus tiv thaiv thiab kho cov teeb meem nyob hauv qhov uas siab zog los sis qis zog ntawm cov kaus hniav kom sib haum ua ke thaum ntxo los sis xo noj. Tus Kws Kho Hniav Menyuam Yaus: Ib tus kws kho hniav tshwj xeeb uas muaj qhov txwv kev ua hauj lwm los mus kho cov me nyuam yaus txij thaum yug los mus txog thaum tiav hluas, muab kev kho tiv thaiv ua ntej thiab muab kev kho tiv thaiv ntxhua yam puv ntoob. Tus Kws Kho Pos Hniav: Ib tus kws kho hniav tshwj xeeb uas muaj qhov txwv kev ua hauj lwm kho cov mob ntawm pos hniav thiab tsig nqaij ib ncig ntawm cov kaus hniav. Ntsig Txog Kev Cev Xeeb Tub: Cov kev pab cuam ntsig txog cev xeeb tub yog muaj pib txij thaum paub tias cev xeeb tub thiab tom qab yug tag ntawd mus rau lub hli xaus uas yog 60 hnub ncua sij hawm tom qab kev cev xeeb tub xaus. Tsis hais koj tus zauv cim pab cuam thiab/ los sis ncua ntawm cov kev pab yuav yog li cas, koj muaj cai tau txais tag nrho cov txheej txheem tau them rau kev kho hniav ntev li ntev tau raws li qhov ua tau raws cai thiab cov hauj lwm kom ua. Kev Tso Cai Ua Ntej: Ib qhov kev thov los ntawm ib tus kws kho hniav kom pom zoo tso cai ua ntej nws yuav muab qhov kev pab kho. Cov kws kho hniav tau txais ib tsab ntawv Notice of Authorization (Ceeb Toom ntawm Kev Tso Cai, NOA) los ntawm Medi‑Cal Dental rau cov kev pab uas tau tso cai rau. Tus Kws Ua Hniav Cuav: Ib tus kws kho hniav tshwj xeeb uas ua hauj lwm los mus muab cov hniav cuav los hloov cov hniav uas tsis muaj lawm, cov hniav sib tuav los sis lwm cov los hloov rau. Tus Muab Kev Pab Kho Hniav: Ib tug kws kho hniav, ib tus kws tu hniav (Registered Dental Hygienist in an Alternative Practice), pab pawg kho hniav, tsev kawm kho hniav lossis tsev kho hniav me tau rau npe nyob hauv qhov kev pab cuam Medi‑Cal los mus muab kev saib xyuas lub qhov ncauj rau cov tswv cuab ntawm Medi‑Cal. Ncua Muaj Qhov Txwv: Tsuas yog muab rau cov kev pab cuam Xwm Txheej Ceev nkaus xwb. Tus Nqi Sib Faib Them (Share of Cost): Qhov nyiaj uas koj yuav tsum tau them lossis cog lus yuav them txhua lub hlis rau kev kho mob lossis kho hniav ua ntej Medi‑Cal pib them. Cov Cai: Hais txog yam uas koj yuav tsum tau ua, los sis cov cai uas koj yuav tsum tau coj raws. Lub Luag Haujlwm: Hais txog yam uas koj yuav tau ua, los sis yog qhov tau vam tias koj yuav ua.



Hais Plaub Qib Xeev (State Hearing): Qhov Hais Plaub Qib Xeev yog kev lis dej num raws kev cai lij choj uas tso cai rau cov tswv cuab los mus thov kom rov qab ntsuam xyuas dua ntawm qhov tau tsis kam them lossis tau hloov kho Qhov Thov Kev Tso Cai Kho Mob. Nws los kuj cia rau tus tswv cuab tau txais kev pab lossis tus kws kho hniav los mus thov kom rov qab ntsuam xyuas dua ntawm qhov kev ntxiv nyiaj rov qab. Thov Kev Tso Cai Kho Mob: Ib qhov kev thov uas tau xa los ntawm ib tug kws kho hniav Medi‑Cal kom tau kev tso cai rau qee yam kev kho uas them rau ua ntej yuav pib kho. Ib Qhov Thov Kev Tso Cai Kho Mob yuav tsum tau muaj rau qee yam kev pab thiab rau tej yam tshwj xeeb.

Koj Cov Cai thiab Cov Luag Hauj Lwm

Kuv cov cai thiab cov luag hauj lwm nyob hauv qhov kev pab cuam Medi-Cal yog licas? Thaum koj thov nkag rau Medi‑Cal, koj yuav tau txais daim ntawv teev koj cov cai thiab cov luag hauj lwm uas koj yuav tau ua. Qhov no xam nrog rau qhov koj yuav tau qhia paub thaum koj hloov pauv chaw nyob, cov nyiaj khwv tau los, los sis yog tias muaj leej twg cev xeeb tub los sis yug me nyuam. Koj nrhiav tau daim ntawv teev koj cov cai thiab cov luag hauj lwm nram qab no: http://www.dhcs.ca.gov/services/medi‑cal/Pages/Medi‑CalFairHearing.aspx. Koj los kuj nrhiav tau lub Chav Ua Haujlwm Cov Kev Pab Cuam Saib Xyuas Kev Noj Qab Haus Huv (Department of Health Care Services) tsab cai tsis pub muaj kev ntxub ntxaug ntawm http://www.dhcs.ca.gov/Pages/Language_Access.aspx.

Koj muaj cai los mus: • Tau txais kev saib taus koj thiab hwm koj. • Tau txais cov kev pab kho hniav uas koj tsim nyog tau txais uas yog ib yam kev pab uas

qhov Kev Pab Cuam Medi‑Cal them rau uas muab los ntawm tus kws kho hniav tau tso npe uas koj tau xaiv.

• Muaj peevxwm teem tau caij mus ntsib kws kho hniav raws li lub sij hawm ntev phim tsim nyog.

• Koom nrog rau cov kev sib tham thiab cov kev txiav txim siab txog ntawm cov kev kho hniav uas koj yuav tau muaj, suav nrog rau cov kev kho uas tsim nyog lossis yuav tau muaj xwb xwb.

• Kom muab koj cov ntaub ntawv kho hniav khaws cia txhob pub leej twg paub. Qhov nov txhais tias peb yuav tsis faib tawm koj cov ntaub ntawv kho hniav yam tsis tau koj kev tso cai sau ua ntawv los sis tshwj tsis yog nws tau tso cai los ntawm kev cai lij choj.

• Qhia peb txog cov kev txhawj xeeb ntawm Medi‑Cal Dental, lossis txog ntawm cov kev pab kho hniav uas koj tau txais.

• Tau txais cov lus los yog ntaub ntawv qhia txog Medi‑Cal Dental, cov kws kho hniav thiab cov kev pab uas muaj.

• Saib koj cov ntaub ntawv kho hniav uas muab sau cia. • Thov kom tau kev pab txhais lus tsis tsub nqi rau koj li. • Siv cov kws txhais lus uas tsis yog koj tsev neeg lossis cov phooj ywg. • Xa qhov tsis txaus siab yog tsis muaj neeg pab txais lus rau koj.

Koj cov luag hauj lwm yog: • Muab cov lus qhia rau koj tus kws kho hniav thiab Medi‑Cal kom raug. • Nkag siab koj qhov (cov) teeb meem ntawm cov hniav thiab koom nrog kev teeb homphiaj

kho, ntau li ntau tau, nrog koj tus kws kho hniav.





• Muab koj daim npav BIC rau lawv saib txhua zaum uas koj mus txais kev pab. • Nug cov lus txog ib qho kev mob hniav twg thiab ua tib zoo kom lawv piav cov lus qhia

meej meej rau koj xwv koj thiaj nkag siab. • Teem thiab ceev cov sij hawm teem caij kho hniav. Koj yuav tsum ceeb toom rau koj tus

kws kho hniav yam tsawg kawg yog nees nkaum plaub (24) xuaj moos ua ntej, yog tias koj tso tseg tsis mus raws li qhov tau teem caij cia.

• Pab Medi‑Cal Dental ceev kom cov ntaub ntawv kho mob tam sim no thiaj raug uas yog txhais tias yuav qhia lawv paub yog tias chaw nyob, tsev neeg lossis lwm yam kev pab them nqi kho mob tau hloov licas.

• Ceeb toom rau Medi‑Cal Dental kom sai li sai tau yog tias ib tus kws kho hniav sau nqi ntawm koj tsis raug lossis yog tias koj muaj qhov tsis txaus siab.

• Saib taus Medi‑Cal Dental txhua tus neeg ua haujlwm thiab cov kws kho hniav.

Koj Qhov Khoom Ntiag Tug yog Tseem Ceeb rau Peb

Tshooj no yuav piav seb yuav tau txais cov ntaub ntawv qhia txog ntawm cov ntaub ntawv kho mob yuav raug muab siv li cas thiab nthuav tawm li cas. Nws los kuj yuav piav seb koj tuaj yeem yuav mus saib tau koj cov ntaub ntawv li cas.

Ceeb Toom txog Cov Kev Ua Hauj Lwm Khaws Khoom Ntiag Tug Cia Tsis Pub Lwm Tus Paub (Notice of Privacy Practices) Lub Chav Ua Haujlwm ntawm Cov Kev Pab Cuam Saib Xyuas Kev Noj Qab Haus Huv (Department of Health Care Services) xa tsab ntawv Ceeb Toom txog Cov Kev Ua Haujlwm Khaws Khoom Ntiag Tug Cia Tsis Pub Lwm Tus Paub rau koj ua ib feem ntawm koj pob ntaub ntawv Medi‑Cal txais tos koj. Koj kuj tseem mus muab tau ib daim online uas yog mus saib https://www.dhcs.ca.gov/formsandpubs/laws/priv/Pages/default.aspx. Tsab ntawv ceeb toom no piav txog koj cov cai khoom ntiag tug thiab cov kev xaiv hais txog ntawm koj cov ntaub ntawv kev noj qab haus huv.

Kuv yuav ua licas thiaj saib tau cov ntaub ntawv raug tiv thaiv uas Medi-Cal Dental muaj txog kuv? Koj muaj cai mus thov kom saib tau koj cov ntaub ntawv kev noj qab haus huv uas raug pov thaiv nyob hauv cov ntaub ntawv sau cia uas Medi‑Cal Dental ceev cia. Koj los kuj muaj cai los mus thov luam tawm cov ntaub ntawv ntawd. Tej zaum koj yuav raug tsub ib tus nqi rau tus nqi luam tawm cov ntaub ntawv sau cia thiab tus nqi xa cov ntawv tuaj rau koj. Koj yuav tau txais ib lo lus teb tsis pub dhau 30 hnub tom qab peb txais tau koj qhov kev thov.

Koj yuav tau xa daim duab luam tawm ntawm koj daim ntawv tsav tsheb California, daim npawv qhia tus kheej DMV, los sis tej yam uas tuaj yeem qhia txog koj tus kheej. Koj los kuj yuav tau xa cov ntaub ntawv qhia txog koj li chaw nyob.

Koj tuaj yeem tau txais ib daim foos ua thov qhov no uas yog hu rau lub TSC los si mus hauv online mus sau kom tag thiab luam tawm daim foos:

1. Mus rau www.denti‑cal.ca.gov.

2. Nias lub pob Benefciaries nyob saum qhov kawg ntawm nplooj vam sab (webpage).

3. Nias rau ntawm Denti‑Cal (Fee‑For‑Service).

https://www.dhcs.ca.gov/formsandpubs/laws/priv/Pages/default.aspx

http://www.denti-cal.ca.gov/



4. Nias rau ntawm Forms.

5. Xaiv daim ntawv foos mus rau Request Personal Health Information from Denti‑Cal.

Xa daim ntawv foos sau tiav txhij txhua nrog rau ntaub ntawv qhia tias koj yog leejtwg mus rau:

Correspondence Specialist c/o Delta Dental of California P.O. Box 15539 Sacramento, CA 95852‑1539

Cim Tseg: tej yam uas txhob txwm qhia tsis ncaj kom mus saib tau cov ntaub ntawv hais txog kev noj qab haus huv uas raug pov thaiv yuav raug nplua raws kev cai lij choj.

Medi‑Cal Dental cog lus yuav tiv thaiv cov ntaub ntawv thiab cov lus qhia uas koj muab rau peb. Kom tiv thaiv tsis tso cai mus saib tau lossis nthuav tawm yam uas txhaum cai, kom ceev cov lus qhia cia kom thwj, thiab kom siv raws qhov tsim nyog, Medi‑Cal Dental muaj qhov chaw cia kom zoo thiab muaj cov txheej txheem saib xyuas los tiv thaiv cov ntaub ntawv peb sau cia.

medi-cal dental member handbook€¦ · medi-cal dental lub chaw muab kev pab cuam hauv xov tooj:...

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