How do I apply for Partnership HealthPlan of California (PHC) health benefits?
To enroll in the Medi-Cal program managed by PHC, call or visit your county department that handles Medi-Cal enrollments. This may be called the Department of Social Services, the Department of Health and Social Services, or something similar. You can also enroll in Medi-Cal through Covered California at http://www.coveredca.com/ or toll free at 800 300-1506, 888 889-4500 TTY.
Why did I get a Partnership HealthPlan of California ID card in the mail?
Your received a PHC ID card because you qualified for Medi-Cal benefits in your county. Enrollment in PHC is required for you to get Medi-Cal benefits. Your enrollment in PHC is based on the type of Medi-Cal you receive and the county you live in.
How can I cancel my enrollment in PHC? I did not sign up for this.
Enrollment in PHC is required for you to get Medi-Cal benefits. Members cannot choose to leave PHC to go to State Medi-Cal. You can only cancel your enrollment in PHC for one of the following reasons:
• You have moved to a county not covered by PHC
• You have lost your Medi-Cal eligibility
• Your Medi-Cal coverage changes to a category not covered by PHC
What is covered by PHC?
PHC provides health benefits, for more information, click here http://www.partnershiphp.org/Members/Medi-Cal/Pages/Benefits.aspx
Are podiatry services covered?
PHC members can receive podiatry services if needed. A referral from your Primary Care Provider (PCP) is required.
Are vision services covered?
PHC members are covered for vision services. You can get one routine eye exam and glasses every two years. Check your provider directory for a list of vision providers or contact our Member Services Department at 800 863-4155. We are available to assist you Monday – Friday, 8:00 a.m. – 5:00 p.m.
Are dental services covered?
Dental services are not provided through PHC. For more information about dental services call the State of California Denti-Cal office at 800 322-6384.
How to Get the Medical Care You Need
- Make an appointment to see your doctor for a check-up within 120 days after your Medi-Cal starts.
- When you go to the doctor, bring your Medi-Cal card and your PHC I.D. card with you.
- Always try to keep your appointments and try to get there 15 minutes early.
- If you must cancel your appointment call at least 24 hours in advance.
- Make a list of questions to ask your doctor. Bring your list with you.
- If something is not clear, tell your doctor. If you get home and forgot what your doctor told you, call your doctor's office and ask for the answer or directions again.
- Tell your doctor about all the medicine you are taking, even over-the-counter medicines. You can make a list of your medicines to give to your doctor. When your doctor gives you a new prescription, ask if there are any side effects or foods you should not eat. Ask when the medicine should be taken.
- Only use the emergency room when a delay in treatment could cause death or serious injury.
I need to see a specialist, how do I do that?
If you need specialty care, your Primary Care Provider (PCP) will make a referral for you. This referral from your PCP is your approval to see a specialist. For more information click here http://www.partnershiphp.org/Members/Medi-Cal/Documents/MCMemberHandbook.pdf#search=specialty%20care
Where can I go for urgent care?
First call your Primary Care Provider (PCP). You may speak to someone who answers calls for your PCP when the office is closed. Ask to speak to your PCP or the provider on call. Another provider may take your call when your PCP is not available.
Tell the provider about your condition and follow their instructions.
You can call our Advice Nurse at 866 778-8873, 24 hours a day, 7 days a week.
You can also find Urgent Care Centers in your Provider Directory.
What are my benefits when I'm traveling outside of my residence county and/or out of the state of California (within the United States)?
When you are outside of your county you are only covered for emergency services. If you have a life threatening emergency while you are away from your home, you should go to the closest emergency room.
What does Prior Approval or TAR mean?
Prior Approval is when PHC needs to review a request for health care services before you get them. This is also referred to as a Treatment Authorization Request (TAR).
For more information click here http://www.partnershiphp.org/Members/Medi-Cal/Pages/Prior-Authorization.aspx
What does Special Member or Special Case Managed mean?
Not all members will be assigned to a Primary Care Provider (PCP). Members not assigned to a PCP are called Special Members or Special Case Managed Members. Below are examples of the type of members that are not assigned to a PCP. New members are Special Case Managed for their first month with PHC, unless they have picked a PCP before they joined PHC. Other members will be Special Case Managed after their first month with PHC, such as children in Foster Care, members with End Stage Renal Disease, and members who are enrolled in California Children's Services (CCS).
Even though Special Case Managed Members can see any Medi-Cal provider, Prior Approval is still needed for certain services. If you think you may qualify for Special Case Managed assignment, please contact PHC's Member Services Department.
What If I have a Share-of-Cost (SOC)?
Share-of-cost (SOC) is a set amount you will need to pay providers each month when receiving Medi-Cal covered services. The SOC amount is determined by your Medi-Cal office. After you meet your SOC, you are eligible to receive Medi-Cal covered services for the month with no out of pocket expenses.
If you have questions about your share-of-cost amount, please contact your local Medi-Cal office.
Will I be Responsible for Any Co-Pays, Premiums, or out of pocket expenses?
If you have a Share-of-cost (SOC) (see question above), you will need to pay that amount each month to your provider. There are no other co-payment, premiums or out of pocket expenses if you see and receive Medi-Cal covered benefits through a Medi-Cal provider.
Your local county Medi-Cal office can assist with the following questions:
How long does my Medi-Cal coverage last?
When do I need to reapply for Medi-Cal coverage?
Who should I contact if my benefits are no longer active?
How can I order a new Benefits Identification Card (BIC) card?
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