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Information for new SCFHP DualConnect members

Thank you for enrolling in SCFHP DualConnect. We're glad to have you with us. Below you'll find information about your new plan:

What to expect next

  • Confirmation: We’ll let you know once we receive your enrollment forms.
  • Enrollment verification letter: Once we’ve confirmed your enrollment, we’ll send you a letter. This letter will contain important information such as your SCFHP DualConnect member ID number and other information.
  • Your SCFHP member ID card: Within 10 days of your confirmed enrollment, you will receive your member ID card. It will have your member ID number and your Primary Care Provider’s information on it. You’ll use it for any services under your new plan.

    DualConnect ID Card Front & Back
  • Welcome packet: Soon after you receive your verification letter, you’ll receive a welcome packet with information on navigating your SCFHP DualConnect plan. It also includes forms for you to fill out and return to us, such as a Health Risk Assessment (HRA) form. The HRA helps us understand your health history and areas that we can assist you. We then work with you and your providers to develop your healthcare goals in an Individualized Care Plan (ICP). We encourage you to share this plan with your providers so we can work together to help you get the care and services you need.
  • Welcome call: You’ll receive a phone call from us welcoming you to SCFHP DualConnect. You’ll be able to ask some questions to help you with your new plan.
  • Member Orientation: We offer in-person or online member orientations for new members. It’s optional and no cost to you, but will get you on the right track to get started with SCFHP DualConnect. Go to scfhp.com/welcome to schedule your orientation. Orientations are offered in English, Chinese, Spanish and Vietnamese.
  • Newsletter: You’ll get our quarterly newsletter keeping you up to date with everything you need to know about your SCFHP DualConnect benefits.

See your doctor!

SCFHP recommends that, as a new member, you see your new primary care provider (PCP) as soon as you can. If you are new to Medicare, request your “Welcome to Medicare” preventive visit. Complete your preventive physical exam (Initial Preventive Physical Exam) by December 31, 2023 to receive a $200 grocery incentive*.

If you are not new to Medicare, request your Annual Wellness Visit with your PCP. If you complete your Annual Wellness Visit by December 31, 2023, you can receive a $200 grocery incentive*.

When you call your PCP to schedule your visit, remember to do the following:

  1. Tell the person who answers the phone that you are a member of SCFHP DualConnect.
  2. Give your SCFHP member ID number.
  3. Take your SCFHP member ID card to your appointment.

It is a good idea to take a list of your medications and questions with you to your visit. Be ready to talk to your PCP about your healthcare needs and concerns. And as a common courtesy, call your PCP if you are going to be late or cannot go to your appointment.

*Incentives may not be used for purchase of tobacco, alcohol, or firearms.

What if your current provider isn't part of SCFHP?

If you now see providers who are not in SCFHP's network, in certain cases you may be able to keep seeing them for up to 12 months. Here are the conditions (all must be true):

  • You ask SCFHP to help you by calling Customer Service.
  • You have an ongoing relationship with the non-plan provider, prior to enrollment with SCFHP.
  • The non-plan provider agrees to SCFHP's requirements.
  • The non-plan provider meets SCFHP's applicable professional standards and has no disqualifying quality-of-care issues.

If your providers do not join SCFHP's network by the end of 12 months, you will need to switch to providers in SCFHP's network.

SCFHP will help you:

  • Get surgery or another medical procedure from the nonplan provider as long as it is a covered service, medically necessary, and has already been approved as part of a documented treatment plan.
  • Continue getting care that is a covered service for a newborn child between birth and 36 months, for up to 12 months from the effective date of coverage.
  • Continue getting care that is a covered service for a pregnancy, including postpartum care (up to six weeks after delivery).
  • Continue getting care that is a covered service for the duration of a terminal illness.

SCFHP may also transfer care to a plan provider to make sure your care is not interrupted. Call SCFHP Customer Service if you need help with this process.

Note: Continuity of care protections do not extend to these providers: durable medical equipment, transportation, other ancillary services, or carved-out services.

Enrollees must live in Santa Clara County, be 21 years or older, have both Medicare A and B, and have full-scope Medi-Cal to be eligible for SCFHP DualConnect.

Santa Clara Family Health Plan DualConnect is an HMO D-SNP with a Medicare and Medi-Cal contract. Enrollment in DualConnect depends on contract renewal.

Last updated: 1/18/2023

H4045_23013W Accepted