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 |
| Appointment of Representative (AOR) Instructions | 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 |