It will answer many of your questions about services and benefits covered through medical and additional programs. Member handbook this member handbook tells you about your coverage under l. Member handbook to help provide you with answers to all of your questions about your available health care services, see your medi cal member handbook. Your basic medi cal benefits are the same as those of other medi cal recipients in california, but you also have access to additional. Members cannot choose to leave phc to go to state medical. Ncqa is a notforprofit organization dedicated to improving health care quality. As a member of your county dmcods plan, your county plan is responsible for. You must show your gchp id card and your medical benefits identification card bic when you get any health care services or prescriptions. That could be with a medical managed care plan or with the regular medical fee for service program. Tis handbook tells you about your coverage under l.
Acupuncture acu audiology and hearing aids aud chiropractic chr durable medical equipment and medical supplies dme medical transportation mtr orthotics and prosthetics oap psychological services psy therapies thp. All children that meet the medi cal eligibility requirements, regardless of immigration status, can get comprehensive health care in health net medi cal. Some members who also have certain types of medicare eligibility or who have certain medical conditions do not need to choose a health network or a pcp. If you dont read this handbook now, you should keep it so you can read it later. The medical learning portal mlp brings medical learning tools into the 21. Use this handbook as an addition to the member handbook that you received when you enrolled in your current medical benefit. Medical benefits and coverage san francisco health plan. Coverage under iehp dualchoice qualifies as minimum essential coverage mec. Medi cal handbook page 23 covered california overview affordable coverage and financial support individuals and families with low to moderate income may qualify for federal financial assistance. Member handbook all you need to know about your benefits. The denti cal handbook is provided to you in a table of contents format.
Blue shield of california promise health plan is a managed care organization, wholly owned by blue shield of california, offering medical, cal mediconnect, medicare advantage hmo, and dual eligible special needs plans dsnp. This document explains your rights, benefits, and responsibilities as a member of molina dual options. Were improving and modernizing the way you get medicare information. This member handbook is also called the combined evidence of coverage eoc and disclosure form. California medical dental services beneficiary handbook dentical benefits this section provides an overview of the dental care that is covered by medical. Also known as your evidence of coverage, this document is available for you to download in the following languages at any time. Please call our member services number or see your member handbook for more. You should carry all health cards with you at all times. All children that meet the medical eligibility requirements, regardless of immigration status, can get comprehensive health care in health net. As a member of your county dmcods plan, your ounty plan is. It also explains your rights and responsibilities as a member of l. You became an hpsm member when you were approved for medi cal by the san mateo county human services agency or through the ssi supplemental security income program.
Hpsms medical program received accreditation from the national committee for quality assurance ncqa on january 17, 2020. The benefit information is a brief summary, not a complete description of benefits. Care health plan is a health plan that contracts with both medicare and medi cal to provide benefts of both. Anthem blue cross is the trade name for blue cross of.
Your medical benefit book 2018 community health plan of. Medi cal covers lowincome adults, families with children, seniors, persons with disabilities, pregnant women, children in foster care and former foster youth up to age 26. Longterm services and supports help you stay at home instead. If you would like to learn exact terms and conditions of. The california medi cal dental program provider handbook, also known as the denti cal handbook is updated with the information from the denti cal bulletins each quarter. Kps participation in medical managed care is fundamental to our mission to improve the health of the communities we serve. This member handbook tells you about your coverage under mcp. These services are to help coordinate physical health services, behavioral health services, and communitybased long term services and supports ltss for members with chronic conditions.
Gchp works with the state to help you get the health care you need. Ventura county drug medical organized delivery system dmc. Combined evidence of coverage eoc and disclosure form. Member handbook to help provide you with answers to all of your questions about your available health care services, see your medical member handbook. The goal is to provide a seamless and transparent experience to help you get the information you need to make good health care choices. Anthem blue cross care1st health plan kaiser permanente l.
This includes members with both medical and medicare as well as those with both medical and commercial insurance. Medical provides free and low cost health care coverage for low income adults, families, children regardless of immigration status, older adults, and people with disabilities. If you had apple health coverage in the past or had medicaid before it was known as apple health, we wont mail you a new card. Below is a benefits quick reference guide for beneficiaries effective january 1st, 2018. You may also ask for another copy of the member handbook at no cost to you or visit the. If you have questions, please call iehp dualchoice at 1877273 iehp 4347, 8am8pm. Member handbook what you need to know about your benefits health net combined evidence of coverage eoc and disclosure form 2020. California unitedhealthcare community plan of california. No premium cost for medical, however, those of us working and earning a living pay for medi cal with our taxes.
Care, the member may choose to get services through any health plan partner listed below as long as the plan choice is available. Anthem is a health plan for people who have medical. It explains health care services, behavioral health mental health and substance use disorder services, prescription drug coverage, and longterm services and supports. This member handbook tells you about your coverage under iehp. Your rights and responsibilities as a member of your county dmc. Once your form is processed, the county will let you know if you andor your family member.
Saving your location allows us to provide you with more relevant information. Medical handbook page 1 santa clara county, california. If you have special health needs, be sure to read all sections that apply to you. This member handbook tells you about your coverage under caloptima. Call iehp member services at 1800440iehp 4347 tty 18007184347 to ask for a. Medical member handbook evidence of coverage mar 30, 2018, 15. Certain administrative and support services are provided to calviva health under contractual arrangements with various third parties. If you are enrolled with a medical managed care plan mcp, the mcp is required to assist with transportation according to section 142 ad of the welfare and institutions code. Partnership healthplan of california phc is a nonprofit community based health care organization that contracts with the state to administer medical benefits through local care providers to ensure medical recipients have access to highquality comprehensive costeffective health care. Return the form along with any additional documents requested. Caloptima is the health plan for medical beneficiaries in orange county. Unitedhealthcare community plan of california covers health homes program hhp services for members with certain chronic health conditions.
Identification id cards as a member of gchp, you will get a gchp id card. Caloptima coverage may also end if your local county health and human services office changes how you qualify for medical. Member handbook what you need to know about your benefits. The medi cal eligibility procedures manual mepm provides clarification to county social services staff on policies and procedures for making eligibility determinations for the medi cal program. It also explains your rights and responsibilities as a member of caloptima. To check your eligibility or medi cal application status, call the san mateo county human services agency at 18002238383. You can get this member handbook and other plan materials. Medi cal provides free and low cost health care coverage for low income adults, families, children regardless of immigration status, older adults, and people with disabilities. Below is a benefts quick reference guide for members efective january 1, 2018. Care cal mediconnect plan through december 31, 2018. Health net works with the state of california to help you get the health care you need. What you need to know about your benefits gold coast health. Current member handbook vietnamese opens in a new tab pdf 1. The dentical handbook is provided to you in a table of contents format.
The outreach and education team includes regional representatives, the small provider billing unit spbu and coordinators who are available to train and assist providers to efficiently submit their medical claims for payment. It is a summary of mcp rules and policies and based on the contract between mcp and dhcs. Transportation services are available for all service needs, including those that are not included in the dmcods program. Unitedhealthcare community plan of california medical frequently asked questions. Calviva health works with the state of california to help you get the health care you need. Each person has a different providerone client number that stays with them for life. It also explains your rights and responsibilities as a member of hpsm. Gold coast health plan is the health plan for people who have medical in ventura county. Our member services department is available to help you. Ods plan if you dont read this handbook now, you should keep this handbook so you can read it later. Anthem works with the state of california to help you get the health care you need. Iehp works with the state of california to help you get the health care you need.
What are the available dental benefits under the medical program. If you have questions or need help with your health care services, please call caloptimas customer service department at 1714 246 8500 or tollfree at 1888 587 8088, monday. Health net is a health plan for people who have medi. All children that meet the medical eligibility requirements, regardless of immigration status, can. What you need to know about your benefits gold coast. Dear calviva health member, thank you for being a valued member of calviva health. Medical is financed by the state of california and the federal government. Medi cal feeforservice ffs pharmacy benefit section 15 waiver flexibilities relative to the 2019novel coronavirus covid19 new icd10cm diagnosis code for covid19 antihemophilic factor viii, human, koate available without a tar. Sn 9 health care reform medical addendum i magi order of evaluation, interim process for pregnancy. Member handbook this member handbook tells you about your coverage under hpsm. Who we are partnership healthplan of california phc is a nonprofit community based health care organization that contracts with the state to administer medical benefits through local care providers to ensure medical recipients have access to highquality comprehensive costeffective health care. Member handbook iehp dualchoice cal mediconnect plan. Medical program overview medical is the state of californias version of the federal medicaid program and is. If you dont read this handbook now, you should keep this handbook so you can read it later.
Anthem blue cross and blue cross of california partnership plan, inc. As a member of your county dmcods plan, your ounty plan is responsible for. California department of health care services model member. This member handbook tells you about your coverage under calviva health. Unitedhealthcare community plan of california medical. It will help you understand and use your benefits and services. You should look at the member handbook for a detailed description of coverage benefits and limitations. Unitedhealthcare offers unitedhealthcare community plan of california medical plans for california and eligible counties.
Use this handbook as an addition to the member handbook that you received when you enrolled in your current medi. This plan gives you a choice of doctors and hospitals. It is also provided to you in adobe acrobat reader. Medical provides medical, dental, and vision coverage. About medical benefits and services preventive care for children how to get care. Drug medical organized delivery system member handbook. An evidence of coverage eoc booklet which tells you what your health benefits are as a medical member with calviva health. Guaranteed availability of coverage all health insurance plans except most sold before march 10, 2010 cover. Medical feeforservice ffs pharmacy benefit section 15 waiver flexibilities relative to the 2019novel coronavirus covid19 new icd10cm diagnosis code for covid19 antihemophilic factor viii, human, koate available without a tar.
All information must be completed by the deadline provided by the county or you could risk losing your medical benefits. It also explains your rights and responsibilities as a member of mcp. Jan 27, 2020 navigating medical and specialty health programs. Medi cal provides medical, dental, and vision coverage. It also tells you how to get health services like emergency care, vision care and family planning care. This chart below is to help you understand what services are provided by san francisco health plan sfhp. Member handbook what you need to know about your benefits molina healthcare combined evidence of coverage eoc and disclosure form. Calviva health works with the state of california to help you get the. You will stop being a caloptima member only if you lose your medical eligibility or if you move out of the caloptimas service area. The california medical dental program provider handbook, also known as the dentical handbook is updated with the information from the dentical bulletins each quarter. Jul 01, 2018 use this handbook as an addition to the member handbook that you received when you enrolled in your current medical benefit.
570 316 1650 1395 1401 574 1164 1241 564 945 975 10 488 1007 1104 1603 1028 1020 1532 265 1089 1226 490 356 163 794 1025 940 176 749 533 648 82 661 713 1146 1487 1347 1015