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Please refer to your benefit plan information for complete details of the terms, limitations, and exclusions of your prescription drug coverage. Pharmacy Benefits Welcome Brochure (03/2021)Language Access ServicesNondiscrimination Notice and Notice of Availability of Auxiliary Aids and Services Nondiscrimination Notice and Notice of Availability of Auxiliary Aids and ServicesAmeriHealth Administrators complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. AmeriHealth Administrators does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.AmeriHealth Administrators:%u2022 provides free aids and services to people with disabilities to communicate effectively with us and written information in other formats, such as large print%u2022 provides free language services to people whose primary language is not English and information written in other languagesIf you need these services, contact our Civil Rights Coordinator.If you believe that AmeriHealth Administrators has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator. There are four ways to file a grievance directly with AmeriHealth Administrators:%u2022 by mail: AmeriHealth Administrators,ATTN: Civil Rights Coordinator, 1900 Market Street, Philadelphia, PA 19103; %u2022 by phone: 844-352-1706 (TTY 711), %u2022 by fax: 215-761-0920, or %u2022 by email: AHACivilRightsCoordinator@ahatpa.com.If you need help filing a grievance, our 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 athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.Language Access ServicesATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 844-352-1706 (TTY: 711).ATENCI%u00d3N: si habla espa%u00f1ol, tiene a su disposici%u00f3n servicios gratuitos de asistencia ling%u00fc%u00edstica. Llame al844-352-1706 (TTY: 711). (Spanish)%u6ce8%u610f%uff1a%u5982%u679c%u60a8%u8aaa%u4e2d%u6587%uff0c%u60a8%u53ef%u4ee5%u514d%u8cbb%u7372%u5f97%u8a9e%u8a00%u5354%u52a9%u670d%u52d9%u3002%u8acb%u81f4%u96fb844-352-1706%u3002(Chinese)LO LUS TSEEMCEEB: Yog koj hais lus Hmoob, yeej muaj kev pab txhais lus pub dawb rau koj. Hu rau844-352-1706. (Hmong)CH%u00da %u00dd: N%u1ebfu b%u1ea1n n%u00f3i ti%u1ebfng Vi%u1ec7t, c%u00f3 s%u1eb5n c%u00e1c d%u1ecbch v%u1ee5 h%u1ed7 tr%u1ee3 ng%u00f4n ng%u1eef, mi%u1ec5n ph%u00ed, cho b%u1ea1n. G%u1ecdi 844-352-1706.(Vietnamese)FIIRO GAAR AH: Hadii aad ku hadasho af-soomaali, waxaad heleysaa adeegyada kaalmada luuqada, oobilaash ah. Lahadal 844-352-1706. (Somali)844-352-1706Nondiscrimination Notice and Notice of Availability of Auxiliary Aids and ServicesAmeriHealth Administrators complies with applicable Federal civil rights laws and does not discriminate onthe basis of race, color, national origin, age, disability, or sex. AmeriHealth Administrators does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.AmeriHealth Administrators:%u2022 provides free aids and services to people with disabilities to communicate effectively with us and written information in other formats, such as large print%u2022 provides free language services to people whose primary language is not English and information written in other languagesIf you need these services, contact our Civil Rights Coordinator.If you believe that AmeriHealth Administrators has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator.There are four ways to file a grievance directly with AmeriHealth Administrators:%u2022 by mail: AmeriHealth Administrators,ATTN: Civil Rights Coordinator, 1900 Market Street, Philadelphia, PA 19103;%u2022 by phone: 844-352-1706 (TTY 711),%u2022 by fax: 215-761-0920, or %u2022 by email: AHACivilRightsCoordinator@ahatpa.com.If you need help filing a grievance, our 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 forCivil Rights electronically through the Office for Civil Rights Complaint Portal, available athttps://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201,800-368-1019, 800-537-7697 (TDD). Complaint forms are available athttp://www.hhs.gov/ocr/office/file/index.html.Language Access ServicesATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 844-352-1706 (TTY: 711).ATENCI%u00d3N: si habla espa%u00f1ol, tiene a su disposici%u00f3n servicios gratuitos de asistencia ling%u00fc%u00edstica. Llame al 844-352-1706 (TTY: 711). (Spanish)%u6ce8%u610f%uff1a%u5982%u679c%u60a8%u8aaa%u4e2d%u6587%uff0c%u60a8%u53ef%u4ee5%u514d%u8cbb%u7372%u5f97%u8a9e%u8a00%u5354%u52a9%u670d%u52d9%u3002%u8acb%u81f4%u96fb844-352-1706%u3002(Chinese)LO LUS TSEEMCEEB: Yog koj hais lus Hmoob, yeej muaj kev pab txhais lus pub dawb rau koj. Hu rau 844-352-1706. (Hmong)CH%u00da %u00dd: N%u1ebfu b%u1ea1n n%u00f3i ti%u1ebfng Vi%u1ec7t, c%u00f3 s%u1eb5n c%u00e1c d%u1ecbch v%u1ee5 h%u1ed7 tr%u1ee3 ng%u00f4n ng%u1eef, mi%u1ec5n ph%u00ed, cho b%u1ea1n. G%u1ecdi 844-352-1706.(Vietnamese)FIIRO GAAR AH: Hadii aad ku hadasho af-soomaali, waxaad heleysaa adeegyada kaalmada luuqada, oobilaash ah. Lahadal 844-352-1706. (Somali)844-352-1706%u0412%u041d%u0418%u041c%u0410%u041d%u0418%u0415! %u0415%u0441%u043b%u0438 %u0412%u044b %u0433%u043e%u0432%u043e%u0440%u0438%u0442%u0435 %u043f%u043e- %u0440%u0443%u0441%u0441%u043a%u0438, %u0412%u044b %u043c%u043e%u0436%u0435%u0442%u0435 %u043f%u043e%u043b%u0443%u0447%u0438%u0442%u044c %u0431%u0435%u0441%u043f%u043b%u0430%u0442%u043d%u044b%u0435 %u0443%u0441%u043b%u0443%u0433%u0438 %u044f%u0437%u044b%u043a%u043e%u0432%u043e%u0439 %u043f%u043e%u0434%u0434%u0435%u0440%u0436%u043a%u0438. %u041f%u043e%u0437%u0432%u043e%u043d%u0438%u0442%u0435 %u043f%u043e %u0442%u0435%u043b%u0435%u0444%u043e%u043d%u0443 844-352-1706. (Russian)%u0627%u0646%u062a%u0628%u0627%u0647: %u0625%u0630%u0627 %u0643%u0646%u062a %u062a%u062a%u062d%u062f%u062b %u0627%u0644%u0644%u063a%u0629 %u0627%u0644%u0639%u0631%u0628%u06cc%u0629%u060c %u0641%u0625%u0646 %u062e%u062f%u0645%u0627%u062a %u0627%u0644%u0645%u0633%u0627%u0639%u062f%u0629 %u0627%u0644%u0644%u063a%u0648%u06cc%u0629%u060c %u0645%u062a%u0648%u0641%u0631%u0629 %u0644%u0643%u060c %u0645%u062c%u0627%u0646%u0627 (Arabic (1706-352-844 .%u064b .%u0627%u062a%u0635%u0644 %u0639%u0644%u0649 %u0627%u0644%u0631%u0642%u0645 Xiyyeeffannaa: yoo affan Inglizii kandubbatuu, gargaarsa tajaajilaa afaan,, kafalitii mallee, sifii qobayyaa. 844-352-1706. Bilibilli. (Oromo)ATTENTION : si vous parlez fran%u00e7ais, sachez que vous pouvez b%u00e9n%u00e9ficier de services d'assistance linguistique gratuits. Appelez le 844-352-1706. (French)ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlose Sprachassistenz-Systeme zur Verf%u00fcgung. Rufen Sie die 844-352-1706 an. (German)%u1275%u12a9%u1228%u1275%u1361 %u12a0%u121b%u122d%u129b %u12e8%u121a%u1293%u1308%u1229 %u12a8%u1206%u1290%u1363 %u12eb%u1208%u121d%u1295%u121d %u12ad%u134d%u12eb %u12e8%u124b%u1295%u124b %u12a5%u1308%u12db %u12a0%u1308%u120d%u130d%u120e%u1275 %u12ed%u1230%u1323%u120d%u1362 844-352-1706 %u120b%u12ed %u12ed%u12f0%u12cd%u1209 (Amharic)%uc8fc%uc758: %ud55c%uad6d%uc5b4%ub85c %ub9d0%ud558%uc2e4 %uacbd%uc6b0, %ubb34%ub8cc %uc5b8%uc5b4 %uc9c0%uc6d0 %uc11c%ube44%uc2a4%ub97c %uc774%uc6a9%ud558%uc2e4 %uc218 %uc788%uc2b5%ub2c8%ub2e4. 844-352-1706%ub85c%uc804%ud654%ud558%uc2ed%uc2dc%uc624. (Korean)%u0ec0%u0e8a%u0eb5 %u0e99%u0e8a%u0eb2%u0e9a: %u0e96%u0ec9%u0eb2%u0e97%u0ec8 %u0eb2%u0e99%u0ec0%u0ea7%u0ebb%u0ec9 %u0eb2%u0e9e%u0eb2%u0eaa%u0eb2%u0ea5%u0eb2%u0ea7, %u0e9a%u0ecd %u0ea5%u0eb4 %u0e81%u0eb2%u0e99%u0e8a%u0ec8%u0ea7%u0e8d%u0ec0%u0eab%u0eb7 %u0ead%u0e94%u0ec9%u0eb2%u0e99%u0e9e%u0eb2%u0eaa%u0eb2%u0ec2%u0e94%u0e8d%u0e9a%u0ecd %u0ebc %u0ec8 %u0ec0%u0eaa%u0e8d%u0e84%u0ec8%u0eb2 %u0e9e%u0ec9 %u0ead%u0ea1%u0ec3%u0e8a%u0ec9%u0e87%u0eb2%u0e99%u0eaa%u0e4d%u0eb2%u0ea5%u0eb1 %u0e9a%u0e97%u0ec8%u0eb2%u0e99.%u0ec2%u0e97 844-352-1706.(Laotian)PAUNAWA: Kung nagsasalita ka ng Tagalog, makakakuha ka ng mga serbisyo ng tulong para sa wika nang walang bayad. Call 844-352-1706. (Tagalog)%u179f%ufffd%ufffd %u179b%u17cb%u17d6 %u17d2%u179a%u1794%u179f%u17b7%u1793%u17c1%u1794%u17be%u17a2%ufffd%u1780%u1793%u17b7%ufffd%u1799%ufffd%ufffd%u17c2%u1781%ufffd %u179a %u17c1%u179f%ufffd%u1780%u1798%ufffd%u1787%u17c6%u1793%u17bd%u1799%u17c2%u1795%ufffd%u1780%ufffd%ufffd%u17c2%u178a%u179b%u17a5%u178f%u1782%u17b7%u178f%u17c3%u1790%ufffd%ufffd%u1785%ufffd%u1793%u1795%ufffd%u179b%u17cb%u1787%u17bc%u1793%u17a2%ufffd%u1780%u17d4%u17c1%ufffd%u17c1%u179b%u1781 844-352-1706 %u17d4 (Khmer)Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 844-352-1706. (Pennsylvania Dutch)ATTENZIONE: Se parli Italiano, servizi di assistenza linguistica, gratuiti, sono a tua disposizione. Chiama il numero 844-352-1706. (Italian)%u0ab8%u0abe%u0ab5%u0aa7%u0abe%u0aa8: %u0a9c%u0acb %u0aa4%u0aae%u0ac7%ufffd%u0a9c%u0ab0%u0abe%u0aa4%u0ac0 %u0ac1 %u0aac%u0acb%u0ab2%u0aa4%u0abe %u0ab9%u0acb%u0aaf, %u0aa4%u0acb %u0aad%u0abe%u0ab7%u0abe %u0ab8%u0ab9%u0abe%u0aaf %u0ab8%u0ac7%u0ab5%u0abe%u0a93, %u0aae%u0aab%u0aa4%u0aae%u0abe%u0a82, %u0aa4%u0aae%u0abe%u0ab0%u0abe %u0aae%u0abe%u0a9f%ufffd%u0a89%u0aaa%u0ab2%u0aac%u0acd%u0aa7 %u0a9b%u0ac7. 844-352-1706%u0aaa%u0ab0 %u0a95%u0ac9%u0ab2 %u0a95%u0ab0%u0acb. (Gujarati)UWAGA: Je%u017celi m%u00f3wisz po polsku, mo%u017cesz skorzysta%u0107 z darmowych us%u0142ug pomocy j%u0119zykowej. Zadzwo%u0144 na numer 844-352-1706. (Polish)ATANSYON: Si ou pale krey%u00f2l, gen s%u00e8vis %u00e8d ak lang disponib pou ou gratis. Rele 844-352-1706. (Creole)ATEN%u00c7%u00c3O: Se falar portugu%u00eas, tem dispon%u00edveis servi%u00e7os gratuitos de assist%u00eancia nesta l%u00edngua. Ligue para o 844-352-1706. (Portuguese)%u6ce8%uff1a%u82f1%u8a9e%u4ee5%u5916%u306e%u8a00%u8a9e%u3092%u3054%u5229%u7528%u306e%u65b9%u306b%u306f%u7121%u6599%u306e%u8a00%u8a9e%u30a2%u30b7%u30b9%u30bf%u30f3%u30c8%u30b5%u30fc%u30d3%u30b9%u304c%u3054%u3056%u3044%u307e%u3059%u3002844-352-1706%u306b%u304a%u96fb%u8a71%u304f%u3060%u3055%u3044%u3002(Japanese)%u062a%u0648%u062c%u06be: %u0627%u06af%u0631 %u0628%u06be %u0632%u0628%u0627%u0646 %u0641%u0627%u0631%u0633%u06cc %u0635%u062d%u0628%u062a %u0645%u06cc%u06a9%u0646%u06cc%u062f%u060c %u062e%u062f%u0645%u0627%u062a %u06a9%u0645%u06a9%u06cc %u0632%u0628%u0627%u0646%u06cc %u0628%u06be %u0635%u0648%u0631%u062a %u0631%u0627%u06cc%u06af%u0627%u0646 %u0628%u0631%u0627%u06cc %u0634%u0645%u0627 %u0645%u06be%u06cc%u0627 %u0627%u0633%u062a. %u0628%u0627 %u0634%u0645%u0627%u0631%u0647 1706.352.844 %u062a%u0645%u0627%u0633 %u0628%u06af%u06cc%u0631%u06cc%u062f (Farsi(844-352-170620414 1933154 6-2219