Cal MediConnect member materials
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Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect) documents are available below for easy viewing and to download. If you need a printed version of a document, or a printed document in another language or other formats, such as large print, Braille, and/or audio, please fill out and submit this form.
Member materials
Name | English | Español | Tiếng Việt | 中文 | Tagalog |
---|---|---|---|---|---|
Annual Notice of Changes (ANOC) | Link | Link | Link | Link | Link |
Denti-Cal Provider List | Link | ||||
Durable Medical Equipment (DME) List | Link | Link | Link | Link | Link |
List of Covered Drugs (Formulary) | Link | Link | Link | Link | Link |
Member Handbook | Link | Link | Link | Link | Link |
Provider and Pharmacy Directory | Link | Link | Link | Link | Link |
Summary of Benefits | Link | Link | Link | Link | Link |
Vision Service Plan (VSP) Doctor Directory |
Link |
Forms
Name | English | Español | Tiếng Việt | 中文 | Tagalog |
---|---|---|---|---|---|
Advance Health Care Directive Form | Link | Link | Link | Link | Link |
Appointment of Representative (AOR) | Link | Link | Link | Link | Link |
Member Grievance Form | Link | Link | Link | Link | Link |
Part D Coverage Determination Request | Link | Link | Link | Link | Link |
Part D Prescription Drug Claim Form | Link | ||||
Personal Medication List | Link | Link | Link | Link | Link |
Request for Redetermination of Part D Drug Denial | Link | Link | Link | Link | Link |
Resources
Name | English | Español | Tiếng Việt | 中文 | Tagalog |
---|---|---|---|---|---|
Best Available Evidence—CMS Policy | Link | ||||
Language Assistance Services | Link | Link | Link | Link | Link |
List of Drugs Requiring Step Therapy | Link | ||||
Medicare/Medi-Cal—Update your Information | Link | Link | Link | Link | Link |
Member Rights and Responsibilities | Link | Link | Link | Link | Link |
Notice of Nondiscrimination | Link | Link | Link | Link | Link |
Notice of Privacy Practices | Link | Link | Link | Link | Link |
Prior Authorization Requirements | Link | ||||
Quality Improvement Program Description | Link | ||||
Silver&Fit Flyer - Fitness Benefit | Link | Link | Link | Link | Link |