Nondiscrimination and Accessibility Notice (ACA §1557)

Midwest Dental and Merit Dental comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. Midwest Dental and Merit Dental do not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

Midwest Dental and Merit Dental provide free aids and services to people with disabilities to communicate effectively with us, such as:

· Qualified sign language interpreters
· Written information in other formats (large print, audio, accessible electronic formats, other formats)
· Provides free language services to people whose primary language is not English, such as:
· Qualified interpreters
· Information written in other languages

If you need these services, please visit your local Midwest Dental or Merit Dental office.

If you believe that Midwest Dental and Merit Dental have 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:

Midwest Dental and Merit Dental:
Section 1557 Coordinator
680 Hehli Way
Mondovi, WI 54755
(844) 758-5900
section1557coordinator@midwest-dental.com

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, we are 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 , 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