Welcome Individual & Family Plan Members

This page is for CCHP Members who purchase their own CCHP coverage and who do not have CCHP coverage through an employer. To learn more about your plan, please review the following:

$25 Copayment Plan
Our copayment plan feature set payments (or copayment) for certain covered services, so you'll always know in advance what your out-of-pocket costs for prescriptions and doctor visits will be.

To learn more, review the following:

CCHP Jade CCHP Amber
  • No Annual Deductible
  • Free Preventive Services
  • Free Routine Lab Services & X-Rays
  • Free Maternity Care
  • $30 office visit copay
  • Includes a Prescription Drug Plan
  • Lower premiums (Annual Deductibles: Individual/Family $3000/5000)
  • Free Preventive Services
  • Free 3 Primary Care Physician Visits
  • $50 office visit copay
  • Includes a Prescription Drug Plan

Conversion Plan Coverage

A person who has been a Member but is no longer eligible for group coverage, including any COBRA or Cal-COBRA, and who is entitled to convert to individual conversion plan coverage, may apply without a medical evaluation for individual conversion plan coverage, and pay the first prepayment fee, within 63 days of loss of eligibility. Conversion plan coverage begins at the time group coverage ends. Conversion plan benefits may differ from the coverage provided by this group plan, and the cost of the conversion plan will be higher than the group plan.

You may not convert to our Individual-Conversion Plan if any of the following is true:

  • You continue to be eligible for coverage through your Group (but not counting COBRA, Cal-COBRA, or State Continuation Coverage after COBRA or Cal-COBRA coverage)
  • Your membership ends because your Group's Agreement with us terminates and it is replaced by another plan within 15 days of the termination date
  • We terminated your membership under "Termination of Coverage" section
  • You live outside CCHP's service area, except that the Member's or the Member's Spouse's otherwise-eligible children may be eligible to be covered Dependents even if they live in (or move to) the service area (please refer to "Who may Apply for Membership" in the "Eligibility, Enrollment and Effective Dates" section for more information)

State Continuation Coverage

New enrollments are no longer available for State Continuation Coverage under Section 1373.621 of the California Health and Safety Code. If you are already enrolled in State Continuation Coverage, your coverage terminates on the earliest of:

  • The date your Group's Agreement with us terminates
  • The date you obtain coverage under any other group health plan not maintained by your Group, regardless of whether that coverage is less valuable
  • The date you become entitled to Medicare
  • Your 65th birthday
  • Five years from the date your COBRA or Cal-COBRA coverage was scheduled to end, if you are a Member's Spouse or former Spouse
  • The date your membership is terminated for nonpayment of premiums as described under "Termination or Cancellation by the Plan" section

  

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).