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Information for new members

Welcome to Santa Clara Family Health Plan (SCFHP)! We're glad to have you with us. Below you'll find resources and information to help you get started.

If you have any questions, call Customer Service:

  • Medi-Cal members, call 1-800-260-2055, Monday through Friday, 8:30 a.m. to 5 p.m.
  • Cal MediConnect members, call 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m.
  • TTY/TDD users, call 1-800-735-2929 or 711.

Watch your mailbox!

If you are a new SCFHP Medi-Cal member, you will receive a member ID card and new member welcome kit in the mail. Your ID card will arrive within 10 days of your effective date of coverage. The welcome kit includes:

  • Welcome letter
  • Notice of availability of the Member Handbook (or Evidence of Coverage, EOC) and Drug Formulary
  • Notice of availability of the Provider & Pharmacy Directory or a copy of the directory
  • Health Information Form (HIF)

See your doctor!

SCFHP recommends that, as a new member, you see your new primary care provider (PCP) in the next 90 days for an Initial Health Assessment (IHA). The purpose of the IHA is to help your PCP learn your healthcare history and needs. Your PCP may ask you some questions about your health history or may ask you to complete a questionnaire. Your PCP will also tell you about health education counseling and classes that may help you.

When you call your PCP to schedule your IHA, remember to do the following:

  1. Tell the person who answers the phone that you are a member of SCFHP.
  2. Give your SCFHP member ID number.
  3. Take your SCFHP member ID card to your appointment.

It is a good idea to take a list of your medications and questions with you to your visit. Be ready to talk to your PCP about your healthcare needs and concerns. And as a common courtesy, call your PCP if you are going to be late or cannot go to your appointment.

What if your current provider isn't part of SCFHP?

If you now see providers who are not in SCFHP's network, in certain cases you may be able to keep seeing them for up to 12 months. Here are the conditions (all must be true):

  • You ask SCFHP to help you by calling Customer Service.
  • You have an ongoing relationship with the non-plan provider, prior to enrollment with SCFHP.
  • The non-plan provider agrees to SCFHP's requirements.
  • The non-plan provider meets SCFHP's applicable professional standards and has no disqualifying quality-of-care issues.

If your providers do not join SCFHP's network by the end of 12 months, you will need to switch to providers in SCFHP's network.

SCFHP will help you:

  • Get a surgery or other medical procedure from the nonplan provider as long as it is a covered service, medically necessary, and has already been approved as part of a documented treatment plan.
  • Continue getting care that is a covered service for a newborn child between birth and 36 months, for up to 12 months from the effective date of coverage.
  • Continue getting care that is a covered service for a pregnancy, including postpartum care (up to six weeks after delivery).
  • Continue getting care that is a covered service for the duration of a terminal illness.

SCFHP may also transfer care to a plan provider to make sure your care is not interrupted. Call SCFHP Customer Service if you need help with this process.

Note: Continuity of care protections do not extend to these providers: durable medical equipment, transportation, other ancillary services, or carved-out services.

Getting a medical exemption from plan enrollment

If you are a new member who is already receiving treatment or services for a complex medical condition, including pregnancy, you may prefer to stay in the Medi-Cal Fee-For-Service Program. If so, you or your health care provider may call Health Care Options at 1-800-430-4263 or visit their website at healthcareoptions.dhcs.ca.gov.

You can ask Health Care Options about a medical exemption. This means that you will be exempt from joining a managed care plan. You must show Health Care Options that you qualify. To qualify, you must prove that you have a "complex medical condition" and need to continue care with the healthcare provider you are seeing.

What is a Health Information Form (HIF) and why is it necessary?

The HIF is a survey that helps us understand your health needs. Filling out the HIF is voluntary. It will help us better support you. Your answers are confidential, and you will not be denied care based on any information you give us.

If you have questions about completing the form, please call Customer Service.

You can return the completed HIF in the postage-paid envelope included in your welcome kit to:

Santa Clara Family Health Plan
PO Box 18880
San Jose, CA 95158

You can also find the HIF in English, Spanish, Vietnamese, Simplified Chinese, and Tagalog on our Forms & Documents page.