Commercial

Geoffrey GomezHealth Net

MinuteClinic Locations and Services

Southern CaliforniaLos Angeles/Ventura countiesAgoura5623 Kanan RoadArcadia1401 S. Baldwin AvenueBurbank511 N. Hollywood WayLos Angeles10889 Wellworth AvenueManhattan Beach2900 N. Sepulveda BoulevardMarina Del Rey13171 Mindanao WayMontrose2037 Verdugo BoulevardPomona775 E. Foothill BoulevardReseda19353 Victory BoulevardSanta Clarita25880 McBean ParkwaySanta Monica2505 Santa Monica BoulevardSherman Oaks14735 Ventura BoulevardThousand Oaks2791 Agoura RoadTorrance4235 Pacific Coast HighwayWest Hollywood8491 Santa Monica BoulevardOrange/Riverside countiesAliso Viejo26891 Aliso Creek RoadBuena Park8850 Valley View StreetCosta Mesa1150 Baker StreetEastvale14220 Schleisman Road

Huntington Beach19121 Beach BoulevardIrvine14330 Culver DriveMission Viejo25272 Marguerite ParkwayRiverside491 E. Alessandro BoulevardSan Clemente638 Camino de Los MaresSeal Beach921 Pacific Coast HighwayTemecula• 29610 Rancho California Road• 33205 U.S. Highway 79Yorba Linda18080 Imperial HighwaySan Diego County Carlsbad• 2510 El Camino Real• 7740 Rancho Santa Fe RoadChula Vista645 E. Palomar StreetEl Cajon2760 Fletcher ParkwayEscondido318 W. El Norte ParkwayMira Mesa8260 Mira Mesa BoulevardPacific Beach1792 Garnet AvenuePoway12358 Poway RoadRancho Bernardo16773 Bernardo Center DriveSan Diego• 4829 Clairemont Drive• 5644 Mission Center Road• 9730 Mission Gorge Road• 3327 Rosecrans StreetSolana Beach683 Lomas Santa Fe Drive

The MinuteClinic1 is a walk-in health care facility, generally inside

CVS/pharmacy stores. MinuteClinics are staffed by nurse practitioners

and physician assistants who provide unscheduled treatment for common

non-emergency illnesses and injuries when your primary care physician is

not available.

Northern CaliforniaContra Costa CountyDanville650 San Ramon Valley BoulevardSan Ramon2455 San Ramon Valley BoulevardWalnut Creek738 Bancroft RoadSacramento CountyElk Grove5040 Laguna BoulevardFair Oaks8101 Greenback LaneSacramento1350 Florin RoadSan Mateo CountyBurlingame1871 El Camino RealFoster City987 E. Hillsdale BoulevardSanta Clara CountyCampbell1720 S. Bascom AvenueCupertino10455 De Anza BoulevardMountain View2630 W. El Camino RealSan Jose2514 Berryessa RoadSanta Clara2700 Homestead RoadSunnyvale576 E. El Camino Real

You can go to

www.minuteclinic.com

to get:

• a current list of

locations,

• addresses and

directions,

• clinic hours, and

• other important

information.

1 MinuteClinics are not located in all California counties. Refer to www.minuteclinic.com for the most up-to-date locations.

Accessing careYou do not need prior authorization or a referral from your primary care physician or contracting physician group in order to obtain access to MinuteClinic services. Members traveling in another state which has a CVS/pharmacy with a MinuteClinic can access MinuteClinic covered services under the terms of the Evidence of Coverage. However, a referral from your contracting physician group or primary care physician is required for any specialist consultations recommended by the MinuteClinic medical staff.

You will receive a written summary at the conclusion of each MinuteClinic visit. With your permission, summaries of your MinuteClinic visit, regardless of visit type, are sent to your primary care physician. If you require a non-emergency referral to a specialist, you will be referred back to your primary care physician for coordination of such care.

Available servicesPreventive care services that may be obtained at a MinuteClinic include services such as vaccinations; health condition monitoring for asthma, diabetes, high blood pressure, or high cholesterol; and wellness and preventive services including, but not limited to, asthma, cholesterol, diabetes and blood pressure screenings, pregnancy testing, and weight evaluations.

Non-preventive care services that may be obtained at a MinuteClinic include services such as the evaluation and diagnosis of:

• minor illnesses, including flu, pinkeye, allergy or sinus symptoms, body aches, and motion sickness prevention;

• minor injuries, including blisters, burns, sprains (foot, ankle or knee), and wounds and abrasions; and

• minor skin conditions, such as minor infections, rashes, sunburns, wart treatment, or poison ivy.

Services or supplies obtained from a MinuteClinic that are not specified as covered in your Evidence of Coverage are excluded. MinuteClinics are not intended to replace your primary care physician or specialist physician as your primary source for regular monitoring of chronic conditions.

Contact usFor additional information or questions about MinuteClinics, please call the Health Net of California, Inc. (Health Net) Customer Contact Center number on your member ID card.

Always present your

Health Net member

ID card at the time

of service.

Subscriber Name

John Doe

Member Name

John Doe

Subscriber #R000000

Issue Date 01-01-2017

Member # XX1

Group # 0000A

Group Name

ABC Company

HMO

In addition to the State of California nondiscrimination requirements (as described in benefit coverage documents), Health Net of California, Inc. (Health Net) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Health Net does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Health Net:• 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, accessible electronic formats, other formats).

• 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 Health Net’s Customer Contact Center at:

On Exchange/Covered California 1-888-926-4988 (TTY: 711)Off Exchange 1-800-522-0088 (TTY: 711)

If you believe that Health Net 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 by calling the number above and telling them you need help filing a grievance; Health Net’s Customer Contact Center is available to help you. You can also file a grievance by mail, fax or online at:

Health Net of California, Inc. PO Box 10348 Van Nuys, CA 91410-0348

Fax: 1-877-831-6019 Online: healthnet.com

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, 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, 1-800-368-1019 (TDD: 1-800-537-7697).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Nondiscrimination Notice

Health Net of California, Inc. is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved.

BKT012873EO00 (5/17)