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Welcome CCHP Group Plan Members

This page is for CCHP Members who have CCHP coverage through an employer. To learn more about your plan, please review the following:

 

• CCHP Physicians and Hospitals
• List of Covered Drugs (Formulary) (English)
• Provider Directory (English and Chinese)
• Member Rights and Responsibilities (English and Chinese)
• How to File an Appeal or Grievance

Dental Plan Rider (PDF):

• Dental Plan Rates
• Dental Plan Summary of Benefits
• Dental Plan Dentist Directory

Vision Plan Rider (PDF):

• Vision Plan Rates & Summary of Benefit
• Vision Plan Doctor Directory

Prior Authorization Process

Decisions regarding requests for authorization will be made only by licensed physicians or other appropriately licensed medical professionals.

CCHP and its participating medical group have certain procedures that will make the authorization decision within the time frame appropriate for your condition, but no later than five business days after receiving all the information (including additional examination and test results) reasonably necessary to make the decision, except that decisions about urgent services will be made no later than 72 hours after receipt of the information reasonably necessary to make the decision. If the medical group needs more time to make the decision because it doesn't have information reasonably necessary to make the decision, or because it has requested consultation by a particular specialist, you and your treating physician will be informed about the additional information, tests, or specialist that are needed, and the date that the medical group expects to make a decision. Your treating physician will be informed of the decision within 24 hours after the decision is made by telephone or facsimile. The plan will notify the physician and the Member in writing within two days of making the determination. If the medical group does not authorize all of the Services, you will be sent a written decision and explanation within two business days after the decision is made.

Continuity of Care

Keeping your doctor/patient relationship is important. When a Primary Care Physician (PCP or specialist resigns or is terminated from the medical group, the plan will notify the Member in writing to assist the Member in transitioning care to another medical group physician. If the contract between The Plan, a provider group, or an acute care hospital terminates, the plan will also notify the affected Members. Members who contact CCHP to request Continued Care from a terminated provider will be sent a Continuity of Care request packet by the Member Services Department. The packet includes a Continuity of Care request form. Member must submit a Continuity of Care request form and related dcouments to the Utilization Review/Care Management Department (attn: UM Director) within 30 calendar days (however, an exception to this 30-day deadline will be made for good cause) of:

• The terminated provider's effective date of termination, or
• The newly enrolled Member's effective date of coverage with the plan

Questions or Concerns

Whenever you have questions or concerns, please call CCHP Member Services. Our team of friendly bilingual representatives will answer questions about your benefits, provider network information and procedures for using the plan.You may contact our Member Services Department from 8:00 a.m. to 8:00 p.m., seven days a week at 1-415-834-2118 (TTY 877-681-8898).