2023 DualConnect benefits & copays
Santa Clara Family Health Plan DualConnect (HMO D-SNP) (DualConnect), a Medicare Medi-Cal Plan, coordinates all of your Medicare and Medi-Cal benefits under one health plan, including:
- Preventive, wellness, and chronic disease management services
- Emergency and urgent care
- Prescription medications, including Part D prescription coverage
- Behavioral health services
- Long-term services and supports (LTSS)
- Community Supports
You can find a description of the 2023 benefits and copays in the sections below.
For more information, call SCFHP DualConnect Customer Service or read the SCFHP DualConnect materials below.
Annual Notice of Changes (ANOC)
Member Handbook (EOC)
Summary of Benefits
Provider and Pharmacy Directory - Updated 5/31/23
List of Covered Drugs (Formulary) - Updated 5/31/23
List of Durable Medical Equipment (DME)
Prior Authorization Requirements(Updated 5/31/23)
Step Therapy Requirements (Updated 5/31/23)
Language Assistance Services
Benefits and services
- Behavioral health services (mental health and substance abuse treatment)
- Chiropractic services
- Dental care (You must get covered dental services through the Medi-Cal Dental Program. These services are a limited benefit. Contact Medi-Cal Dental toll-free at 1-800-322-6384 (TTY: 1-800-735-2922) for more information about covered dental care or go to www.denti-cal.ca.gov
- Diabetes Prevention Program
- Doctor visits
- Durable medical equipment
- Emergency services, including ambulance
- Fitness benefit. See the Fitness benefit page for more information.
- Hearing services, including hearing aids, up to $1,510 maximum allowance per member for both ears combined per fiscal year (July 1 – June 30)
- Hospital stay
- Lab tests, X-rays, or other medical tests
- Long-term services and supports (LTSS), including Community-Based Adult Services (CBAS), and Nursing Facilities (NF). LTSS is not a benefit for SCFHP DualConnect members outside of the Santa Clara County service area
- Occupational, physical, or speech therapy
- Prescriptions, over-the-counter drugs, and other wellness items
- Skilled nursing care
- Transportation services: non-emergency medical transportation and non-medical transportation
- Urgent care
- Vision care: one routine exam every year (a referral may be required) and up to $200 for eyeglasses (frames and lenses) or up to $200 for contact lenses every two years. Benefits are provided through Vision Service Plan (VSP).
You can ask for published materials for free in other formats, such as large print, braille, or audio. Call SCFHP DualConnect Customer Service for help.
If you are more comfortable speaking a language other than English, SCFHP can help you. Whether you are contacting SCFHP or visiting a doctor, we have interpreters available. Tell your doctor you would like an interpreter for your visit.
Know your rights
- You can get an in-person or telephone interpreter at no cost to you. This includes American Sign Language.
- When you go to the doctor, interpreters are available 24-hours a day.
- You can ask for SCFHP DualConnect materials written in other languages.
How can you get an interpreter?
Tell your doctor’s office you would like one. You can do this when you call to set up your next visit. You can also ask us for an interpreter or for translated materials.