MEMBER - GRIEVANCE FORM
Live life. Smiling.
PrimeCare Dental Plan of California is subject to the requirements of Chapter 2.2 of Division 2 of California Health and Safety Code and Subchapter 5.5 of Chapter 3 of Title 28 of the California Administrative Code. Any provision required to be in the Subscriber Agreement binds the Plan whether or not included in your subscriber agreement, i.e. the Plan Contract.
A copy of the formal Grievance Procedure for the PrimeCare Dental Plan is available for review by contacting a Member Service Representative. You may telephone your complaint by calling a Member Service Coordinator at 1-800-937-3400, or you can fax it to (909) 483-5351, or by writing to:
For our limited English proficient members, our LAP (Language Assistance Program) allows you to access free interpretation services in your native language at 1-800-937-3400. Upon receipt of this complaint, we will acknowledge your grievance in writing and begin an investigation into the circumstances of your complaint. You will be advised, in writing, as to the disposition of this complaint within thirty (30) days of receipt of this complaint by PrimeCare Dental Plan. If you are not satisfied with the disposition of the complaint, you are entitled to exercise any of the alternative remedies above, in Exhibit W-2.