CCHP Senior Select Program (HMO SNP)
A Medicare Advantage HMO Plan for people with both Medi-Cal and Medicare
CCHP Senior Select Program (HMO SNP) Members receive all the benefits of traditional Medicare, plus more, including the Medicare Part D drug benefit. You are invited to a free seminar where you will learn about the benefits of the CCHP Senior Select Program (HMO SNP).
You may be eligible for our CCHP Senior Select Program (HMO SNP) if you:
- Are enrolled in Medicare Parts A, Part B and Medi-Cal. (This includes those who are disabled.)
- Live within the City and County of San Francisco.
- Agree to use CCHP providers.
For benefit and enrollment information, review the following downloadable PDFs:
Please click on the plan year tabs (2012) below for downloadable PDFs.
- Summary of Plan premiums & deductibles Chinese Spanish
- Summary of Benefit (including information about the Medication Therapy Management Program) Chinese Spanish
- Annual Notice of Change and Evidence of Coverage Chinese Spanish
- Comprehensive Formulary (including information about Formulary Exceptions and Transition process) Chinese Spanish
- Provider & Pharmacy Directory Chinese Spanish
- Enrollment Form Chinese Spanish
- Low Income Subsidy (LIS) Premium Summary Chart
- Notice of Privacy Practices
-
2012 Dental Supplemental Booklet (English & Chinese)
Spanish
- 2012 Dental Evidence of Coverage Chinese Spanish
- 2012 Dental Provider Directory (English & Chinese) Spanish
Cost Sharing and Deductibles
| Monthly Plan Premium (If you are eligible for this plan, Medicare will pay for your monthly plan premium) |
$0 | ||
| Doctor Office Visits | $0 copay |
||
| X-Rays, Lab | |||
| Diagnostic Radiology Services | |||
| Worldwide Emergency Care | |||
| Ambulance Services | |||
| Outpatient Surgery | |||
| Transportation (up to 36 one-way medical trips / per year) | |||
| Personal Care Coordinator | |||
| Outpatient Surgery | |||
| Hospitalization Services | |||
| Skilled Nursing Facility | |||
| Durable Medical Equipment | |||
| Acupuncture | |||
| Home Health Care | |||
| Vision Services (One pair of glasses every year provided by VSP) | |||
| Dental Services (Provided by Delta Dental) |
$0 to $12 copay for oral exams $0 copay for up to 1 dental x-ray(s) every year $4 to $23 copay for up to 2 cleaning(s) every year Additional benefits available |
||
| Part D: Prescription Drug Coverage (for Drugs on CCHP Formulary) |
Drug Tier | copay vary based on the level of Extra Help eligibility | |
Initial Coverage: Costs for Generic and Other drugs |
Generics | $0 / $1.10 / $2.60 | |
| All Others | $0 / $3.30 / $6.50 | ||
Coverage Gap: After yearly out-of-pocket drug costs reach $4,700 |
Generic & All Others | $0 copay | |
The formulary contains information on how it might be changed during the year
Can the Formulary change? Generally, if you are taking a drug on our formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug during the coverage year except when a new, less expensive generic drug becomes available or when new adverse information about the safety or effectiveness of a drug is released. Other types of formulary changes, such as removing a drug from our formulary, will not affect members who are currently taking the drug. It will remain available at the same cost-sharing for those members taking it for the remainder of the coverage year. We feel it is important that you have continued access for the remainder of the coverage year to the formulary drugs that were available when you chose our plan, except for cases in which you can save additional money or we can ensure your safety. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug or move a dug to a higher cost sharing tier, we must notify affected members of the change at least 60 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and provide notice to members who take the drug. To get updated information about the drugs covered by the Plan call Member Services at 1-888-775-7888, 7 days a week from 8:00 a.m. to 8:00 p.m. TTY/TDD users should call (877) 681-8898. In the event of a mid-year non-maintenance formulary change you can find the changes on our Web site at www.cchphmo.com.
Find a Doctor
To search for a CCHP doctor by specialty, gender or zip code, or to find a doctor who speaks additional languages, click on the link below and it will take you to our medical group's (Chinese Community Health Care Association) Web site.Hospitals
We contract with several hospitals, including:- Chinese Hospital
- St. Francis Memorial Hospital
- California Pacific Medical Center
- St. Mary's Medical Center
Request Information
For additional information, call 415-955-8800 x 3256, toll-free at 1-888-681-3888 or request information online. TTY 1-877-681-8898 for hearing impaired, Monday thru Friday, 8:00 AM - 8:00 PM.CCHP Senior Select Program (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2014. NCQA's approval is based on a review of CCHP Senior Select Program (HMO SNP)'s Model of Care and is an indicator of compliance with CMS requirements. NCQA's approval is not an endorsement by CMS and/or NCQA of CCHP Senior Select Program (HMO SNP) or the quality of service provided by CCHP Senior Select Program (HMO SNP). CCHP Senior Select Program (HMO SNP) will still need to be approved each year by CMS in order to operate. If you have questions regarding our approval by the NCQA, please contact us at 415-834-2118.
CMS Website Best Available Evidence Policy Page
H0571_2012_175 CMS Approved MMDDYYYY Pending CMS Approval
Last updated 02022012
