STAGE DEV MAY, 2013

Minimum Coverage HMO

Minimum Coverage HMO

Minimum Coverage HMO Plan Information

tab01 minimum-coverage-hmo

2017 Benefit Highlights

Plan Benefit Highlights

Pediatric Dental Summary

Pediatric Vision Summary

Individual & Family Plans Rate - San Francisco County

Individual & Family Plans Rate - Northern San Mateo County

Summary of Benefits (SBC)

Health Plan Benefits and Coverage Matrix

Evidence of Coverage (EOC)

CCHP Provider Directory - Covered CA (English and Chinese)

To start an online Provider Search, click here

CCHP Pharmacy Directory - Covered CA (English)

List of Covered Drugs (Formulary) (English)* (No changes made since 6/2017)

Formulary Changes for 2017 (English)

* There are four tiers in the drug formulary. Tiers include the types of drugs that are covered. Please refer to your Evidence of Coverage and Disclosure Form for details.

Tier Definition
1 1) Most generic drugs and low cost preferred brands.
2 1) Non-preferred generic drugs or;
2) Preferred brand name drugs or;
3) Recommended by the plan's pharmaceutical and therapeutics (P&T) committee based on drug safety, efficacy and cost.
3
 
1) Non-preferred brand name drugs or;
2) Recommended by P&T committee based on drug safety, efficacy and cost or;
3) Generally have a preferred and often less costly therapeutic alternative at a lower tier.
4

 

1) Food and Drug Administration (FDA) or drug manufacturer limits distribution to specialty pharmacies or;
2) Self administration requires training, clinical monitoring or;
3) Drug was manufactured using biotechnology or;
4) Plan cost (net of rebates) is >$600.
 
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** (Note: Please note that this is an estimate only. Actual cost depends on the status of your deductible balance, if any, and any applicable limitations or exceptions.)

CCHP Pharmaceutical Management Procedures (English)

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STAGE DEV MAY, 2013