2020 Benefits & Copays
2020 Benefits & Copays
- Medical care
- Prescription medications, including Part D Prescription coverage
- Behavioral health care
- Long-term services and supports (LTSS), which consists of Community-Based Adult Services (CBAS), Multipurpose Senior Services Program (MSSP) and Nursing Facilities (NF)
Ask us to make a coverage decision. A coverage decision is an initial decision we make about your benefits and coverage or about the amount we will pay for your medical services, items, or drugs. We are making a coverage decision whenever we decide what is covered for you and how much we pay.
If you or your doctor are not sure if a service, item, or drug is covered by Medicare or Medi-Cal, either of you can ask for a coverage decision before the doctor gives the service, item, or drug.
Go to Coverage Decisions & Exceptions to learn how to ask for a coverage decision about a drug.
To ask for a coverage decision, call, write, or fax us, or ask your representative or doctor to ask us for a decision.
You can call us at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.
Each year, SCFHP looks for changes and advances in health care that may improve your care. We study new treatments, medicines, procedures, and devices. We refer to this as “new technology.”
To consider the use of any new technology, we look at related scientific reports and other information from the government and medical specialists. We also consider value, how well it works, and safety standards. After careful review, we then decide if the new technology should be covered as a health benefit. Members and providers may submit requests directly to SCFHP to review new technology. You can call us at 1-877-723-4795 (TTY: 711), or fax us at 1-408-874-1957.
You can get the aggregate number of all grievances, appeals, and exceptions filed with SCFHP Cal MediConnect by contacting the SCFHP Grievance and Appeals Department:
Toll Free: 1-877-723-4795
Attn: Grievance and Appeals Department
Santa Clara Family Health Plan
PO Box 18880
San Jose, CA 95158
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.
(8:00 a.m. - 8:00 p.m.,
Monday - Friday)
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.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook.
Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) depends on contract renewal. CMS (the Centers for Medicare & Medicaid Services) must approve SCFHP Cal MediConnect each year. You can continue to get health coverage as a member of our plan only as long as we continue to offer the SCFHP Cal MediConnect Plan for the year in question and CMS renews its approval of the plan. Even if SCFHP leaves the program, you will not lose health coverage. If SCFHP decides not to continue for the next calendar year, we must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
Last updated 10/15/2019