The purpose of the following template is to assist you in writing your accessibility statement. Please note that you are responsible for ensuring that your site's statement meets the requirements of the local law in your area or region.

*Note: This page currently has several sections. Once you complete editing the Accessibility Statement below, you need to delete this section.

To learn more about this, check out our article “Accessibility: Adding an Accessibility Statement to Your Site”.

Accessibility Statement

This statement was last updated on [enter relevant date].

We at [enter organization / business name] are working to make our site [enter site name and address] accessible to people with disabilities.

What web accessibility is

An accessible site allows visitors with disabilities to browse the site with the same or a similar level of ease and enjoyment as other visitors. This can be achieved with the capabilities of the system on which the site is operating, and through assistive technologies.

Accessibility adjustments on this site

We have adapted this site in accordance with WCAG [2.0 / 2.1 / 2.2 - select relevant option] guidelines, and have made the site accessible to the level of [A / AA / AAA - select relevant option]. This site's contents have been adapted to work with assistive technologies, such as screen readers and keyboard use. As part of this effort, we have also [remove irrelevant information]:

Used the Accessibility Wizard to find and fix potential accessibility issues
Set the language of the site
Set the content order of the site’s pages
Defined clear heading structures on all of the site’s pages
Added alternative text to images
Implemented color combinations that meet the required color contrast
Reduced the use of motion on the site
Ensured all videos, audio, and files on the site are accessible

Declaration of partial compliance with the standard due to third-party content [only add if relevant]

The accessibility of certain pages on the site depend on contents that do not belong to the organization, and instead belong to [enter relevant third-party name]. The following pages are affected by this: [list the URLs of the pages]. We therefore declare partial compliance with the standard for these pages.

Accessibility arrangements in the organization [only add if relevant]

[Enter a description of the accessibility arrangements in the physical offices / branches of your site's organization or business. The description can include all current accessibility arrangements - starting from the beginning of the service (e.g., the parking lot and / or public transportation stations) to the end (such as the service desk, restaurant table, classroom etc.). It is also required to specify any additional accessibility arrangements, such as disabled services and their location, and accessibility accessories (e.g. in audio inductions and elevators) available for use]

Requests, issues, and suggestions

If you find an accessibility issue on the site, or if you require further assistance, you are welcome to contact us through the organization's accessibility coordinator:

[Name of the accessibility coordinator]
[Telephone number of the accessibility coordinator]
[Email address of the accessibility coordinator]
[Enter any additional contact details if relevant / available]

You have the right to receive a "Good Faith Estimate" explaining how much your health care will cost.

Under the law, health care providers need to give patients who don't have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit

www.cms.gov/nosurprises/consumers

email or call

FederalPPDRQuestions@cms.hhs.gov

1-800-985-3059