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.


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.

This plan is offered by CCHP, a Coordinated Care plan with a Medicare contract but without a contract with the California Medicaid program. CCHP's plans are open to individuals who are enrolled in Medicare Parts A&B, receive full Medi-Cal benefits and reside in San Francisco. Individuals must have both Part A and Part B to enroll. The Part B premium is covered by the State for full-dual members. Members may enroll in the plan at any time. Contact CCHP Senior Select Program (HMO SNP) for more information. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 800-325-0778; or your Medicaid office. Copay may vary based on the level of Extra Help that a member may receive, please contact Member Services for further detail. You must receive all routine care from plan providers. Except under non-routine circumstances, you must receive prescription drugs from network pharmacies. Limitations, copayments, and restrictions may apply. The benefit information provided herein is a brief summary and not a comprehensive description of available benefits. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. For more information contact the plan. This information is available for free in other languages or formats. Please 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) for additional information.

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