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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

Last updated 1/27/2021

H7890_16035W Accepted