DualConnect member materials
Some of our Santa Clara Family Health Plan DualConnect (HMO D-SNP) (SCFHP DualConnect) materials are online. To view and print them, you must have Adobe Acrobat Reader.
Request a print or alternate format document
SCFHP DualConnect, a Medicare-Medi-Cal Plan, 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.
2023 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) (Updated 5/31/23) |
Link | Link | Link | Link | Link |
| Member Handbook | Link | Link | Link | Link | Link |
| Provider and Pharmacy Directory (Updated 5/31/23) |
Link | Link | Link | Link | Link |
| Summary of Benefits | Link | Link | Link | Link | Link |
| VSP 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 | Link | Link | Link | Link |
| Personal Medication List | Link | Link | Link | Link | Link |
| Request to 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 | ||||
| Evaluation of New Technology | Link | Link | Link | Link | Link |
| Language Assistance Services | Link | ||||
| List of Drugs Requiring Step Therapy (Updated 5/31/23) |
Link | ||||
| Medicare/Medi-Cal Update your Information | Link | Link | Link | Link | Link |
| Member Rights & 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 (Updated 5/31/23) |
Link | ||||
| Quality Improvement Program Description (TBD) | (Coming Soon) | ||||
| YMCA of Silicon Valley Flyer | Link | Link | Link | Link | Link |