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Helpful information

We want to make sure you get the most out of your Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan)! Please read this page carefully to learn more about how to access all of the services and benefits your plan has to offer.

If you have any questions or need more information, please call Customer Service at 1-877-723-4795 ( TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.

Advance Directive

You have the right to say what you want to happen if you are unable to make health care decisions for yourself. Before that happens you can:

  • Fill out a written form to give someone the right to make health care decisions for you. This person can be a spouse, family member, friend, or other person you choose. And your rights as a member of SCFHP apply to this person.
  • Give your doctors written instructions about how you want them to handle your health care if you become unable to make decisions for yourself.

The legal document you can use to give your direction is called an advance directive. There are different types of advance directives and different names for them. For example, a living will and a power of attorney for health care.

You do not have to use an advance directive, but you can if you want to. Find the advance directive form in Member Materials.

At your request, we will send you information about state law regarding advance directives, including any changes to the law, within 90 days after the change is effective.

If you need help or more information, call Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.

Appointing a Representative

To appoint family member, friend, other trusted person, or doctor or other provider as your  representative, call Customer Service and ask for the “Appointment of Representative” form. You can also get the form on the Medicare website at https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms1696.pdf or in Member Materials. You must give us a copy of the signed form. Please note that an AOR is valid for one year from the date you and the representative sign the form. You may cancel the appointment of your representative at any time.

SCFHP will also accept an equivalent written notice so long as it includes the following information:

  • Your name, address, and telephone number;
  • The name, address and telephone number of the person you would like to appoint as your representative;
  • Your Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI), or SCFHP member ID number;
  • Your appointed representative’s professional status or how you are related to him or her (i.e., friend, family member, lawyer, etc.);
  • What subject(s) you would like the person to know or speak on (i.e., a complaint, any coverage decision, a medical appeal only, etc.);
  • A statement that gives the person permission to act on your behalf and that you allow this person to receive your protected health information (PHI);
  • A statement by the person being appointed that he or she accepts the appointment, and
  • A signature from you and the representative along with the date you both signed the document.

You may send the completed and signed AOR form or equivalent written notice to

Attn: AOR Review Team
Santa Clara Family Health Plan
PO Box 18880
San Jose, CA  95158

Case Management & Care Coordination

A case manager is a clinician or other trained person who provides care coordination services for you, especially during care transitions and hospital discharges. When you enroll in SCFHP Cal MediConnect, your health needs will be assessed and a case manager will be offered to help you.

Your case manager can answer your questions, help you find community services, assist you in making your medical appointments, and help you talk to your doctors and other providers. You may call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.

Contact your case manager if you have questions about:

  • Your health care
  • Getting behavioral health (mental health and substance use disorder) services
  • Transportation
  • Long-term services and supports (LTSS). LTSS include Community-Based Adult Services (CBAS), Multipurpose Senior Service Programs (MSSP), and Nursing Facilities (NF).

For information on eligibility requirements for LTSS, see Chapter 2, Section B of the SCFHP Cal MediConnect Member Handbook. Find a copy of the Member Handbook in Member Materials.

 

Continuity of Care

When you first join the plan, you can ask to continue to see your current providers. With some exceptions, we are required to approve this request if we can establish that you had an existing relationship with the providers. If we approve your request, you can continue seeing the providers you see now for up to 12 months for services. During that time, your case manager will contact you to help you find providers in our network. After 12 months, we will no longer cover your care if you continue to see providers that are not in our network.

Continuity of care may be provided for services you are currently getting from a doctor. If you get services from an ancillary provider (such as durable medical equipment, medical supplies, or incontinence supplies for either Medicare or Medi-Cal), SCFHP may transition you to a network provider.

In-Home Supportive Services Santa Clara County

If you need help with your In-Home Supportive Services (IHSS) benefits, contact the County of Santa Clara Social Services Agency:

Call: 1-408-792-1600, Monday through Friday, 8 a.m. to 5 p.m.

Write:

IHSS Social Services
P.O. Box 11018
San Jose, CA 95103-1018

Visit:

353 West Julian St.
San Jose, CA 95110

Website: www.sccgov.org/sites/ssa/other-services/ihss/Pages/ihss.aspx

Health Education

As a SCFHP Cal MediConnect member, you have access to classes and programs to help you manage your health. Health Education services are designed to support our members in living healthier lives. All classes and programs are provided at no cost to SCFHP members. Topics include:

  • Chronic Disease Management (for asthma, diabetes, high blood pressure, etc.)
  • Counseling and Support Services
  • Nutrition and Weight Management
  • Prenatal Education
  • Safety
  • Sexual Health
  • Smoking Cessation

Please visit our Health Education page to see our list of classes and programs. For more information or to sign up for a class, call Customer Service and ask for Health Education. Or login to the mySCFHP member portal.

Health Insurance Counseling & Advocacy Program (HICAP)

The Health Insurance Counseling & Advocacy Program (HICAP) gives free health insurance counseling to people with Medicare. HICAP counselors can answer your questions and help you understand what to do to handle your problem. HICAP has trained counselors in every county, and services are free.

HICAP is not connected with any insurance company or health plan.

Call: 1-408-350-3200, Monday through Friday, 8 a.m. to 5 p.m.

TTY: 711. This number is for people who have hearing or speaking problems. You must have special telephone equipment to call it.

Write:

Sourcewise
3100 De La Cruz Blvd, Suite 310
Santa Clara, CA 95054

Email: community@mysourcewise.com

Website: www.mysourcewise.com

Contact HICAP for questions about your Cal MediConnect plan or other Medicare questions. HICAP counselors can answer your questions about changing to a new plan and help you:

  • Understand your rights,
  • Understand your plan choices,
  • Make complaints about your health care or treatment, and
  • Straighten out problems with your bills.

Long-term services and supports (LTSS)

Long-term services and supports (LTSS) help you stay at home instead of going to a nursing home or hospital. LTSS include Community-Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP), and Nursing Facilities (NF). The services may occur in your home, community, or in a facility. The different types of LTSS are described below:

  • Community-Based Adult Services (CBAS): Outpatient facility based service program that delivers skilled nursing care, social services, occupational and speech therapies, personal care, family/caregiver training and support, nutritional services, transportation, and other services if you meet applicable eligibility criteria.
  • Multipurpose Senior Services Program (MSSP): A California-specific program that provides Home and Community-Based Services (HCBS) to Medi-Cal eligible individuals who are 65 years or older with disabilities as an alternative to nursing facility placement.
  • Nursing Facility (NF): A facility that provides care for people who cannot safely live at home but who do not need to be in the hospital.

Your case manager will help you understand each program. To find out more about any of these programs, call SCFHP Cal MediConnect Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.

Medicare

Medicare is the federal health insurance program for people 65 years of age or older, some people under age 65 with certain disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).

The federal agency in charge of Medicare is the Centers for Medicare & Medicaid Services, or CMS.

To contact Medicare:

Call: 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week.

TTY: 1-877-486-2048. This number is for people who have hearing or speaking problems. You must have special telephone equipment to call it.

Your call is free.

Website: www.medicare.gov

This is the official website for Medicare. It gives you up-to-date information about Medicare.

Nurse Advice Line

Have a health question? Call the Nurse Advice Line!

Call: 1-844-803-6962, 24 hours a day, 7 days a week. This call is free.
We have free interpreter services for people who do not speak English.

When should you call the advice nurse?

  • If you have a health care or behavioral health question.
  • If you are unsure whether to go to the emergency room or urgent care, make a doctor’s appointment, or treat your problem at home.
  • If you or your family member is sick, have a minor injury, or need medical advice.
  • Advice on how and where to get care.
    For example, if you are not sure if your condition is an emergency medical condition, the advice nurse can help you decide if you need emergency services or urgent care. They can tell you how and where to get that care.
  • What to do if you need care and a health care provider’s office is closed.

In an emergency, you should always call 911 or go to the nearest emergency room.

Transportation services

SCFHP provides Non-Emergency Medical Transportation (NEMT) and Non-Medical Transportation (NMT) for members to get medically necessary covered services.

  • NEMT services are for members whose medical or physical condition requires transportation via ambulance, litter van, wheelchair van, or air.
  • NMT services are for members whose medical or physical condition does not require transportation via ambulance, litter van, wheelchair van, or air. Members can use public transportation or private vehicle to get to medically necessary appointments.

To arrange NEMT services:

  1. Have your doctor fill out a Physician Certification Statement (PCS) form to request the type of transportation you need.
  2. Tell your doctor to send the completed form to SCFHP by fax to 1-408-874-1957.
  3. Five (5) business days or sooner before your scheduled appointment, log in to mySCFHP. Go to Request Medical Transportation under Quick Links. Complete the form and submit.
  4. We will call you to confirm your transportation request.

To arrange NMT services:

  1. Three (3) business days before your scheduled appointment, log in to mySCFHP. Go to Request a Taxi under Quick Links. Complete the form and submit.
  2. We will call you to confirm your transportation request.

How do I get a Physician Certification Statement (PCS) form?

Accessibility

You can ask for published materials for free in other formats, such as large print, braille, or audio. Call Customer Service for help.

If you speak a language other than English, language assistance services, free of charge, are available to you. Call Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. The call is free.

Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect) depends on contract renewal.

Last updated 01/08/2020

H7890_15083W Accepted