Members: Programs: Medi-Cal: Benefits and Services
Benefits and Services
Medi-Cal provides medical, dental, and vision coverage. San Francisco Health Plan offers:
- Doctor Visits - over 2,500 providers to choose from
- Vision Care (Glasses & Eye Exams) - over 200 vision service providers
- Hospital and Emergency Room Care - six of the best San Francisco hospitals
- Prescription Drugs - over 200 pharmacies throughout San Francisco
- Regular Check-ups and Immunizations (shots)
- OB/GYN Services and Pregnancy Care
- Family Planning
- Substance Abuse Programs
- Specialty Care - over 2,000 specialists in our network
Summary Of Benefits
This matrix is intended to be used to help you compare coverage benefits and is a summary only. The Evidence of Coverage(
) should be consulted for a detailed description of coverage benefits and limitations.
|
Benefit |
Covered Services
|
Member Pays |
|---|---|---|
Deductible |
$0 | |
| Lifetime Maximum |
Unlimited | |
| Professional Services |
Physician visits including specialty care, inpatient and outpatient medical and surgical services |
No co-payment |
| Outpatient Services |
In a physician’s office, surgery center, or other designated facility including Chemotherapy, dialysis, and radiation |
No co-payment |
| Hospital Inpatient Services |
Medically necessary facility charges room and board, general nursing care, ancillary services including operating room, intensive care unit, prescribed drugs, laboratory, and radiology during inpatient stay |
No co-payment |
| Hospital Outpatient Services |
Medically necessary facility charges, general nursing care, ancillary services including operating room, prescribed drugs, laboratory, chemotherapy, and radiology |
No co-payment |
| Emergency Health Coverage |
24-hour care for emergency services including psychiatric screening, examination and treatment, injury or condition requiring immediate diagnosis in and out of the Plan |
No co-payment |
| Ambulance Services |
Ambulance transportation when medically necessary |
No co-payment |
| Prescription Drug Coverage |
Generic drugs (30-34 day supply); 90- 100 day supply of maintenance drugs (oral and injectable); tobacco cessation drugs for one cycle per benefit year with completion of an SFHP approved tobacco cessation program Inpatient drugs and drugs administered in a doctor’s office, as well as FDA approved contraceptive drugs and devices |
No co-payment |
| Kidney Transplants |
Medically necessary kidney transplant; medical and hospital expenses of a donor or prospective donor; testing expenses and charges associated with procurement of donor organ |
No co-payment |
| Health Education |
Health education materials and classes |
No co-payment |
| California Children Services |
Benefits provided through California Children’s Services |
No co-payment |
| Hospice |
Medically necessary skilled care; counseling, drugs and supplies; short-term inpatient care for pain control and system management; bereavement services, physical, speech and occupational therapies; medical social services short-term inpatient and respite care |
No co-payment |
| Hearing Aids/Services |
Audiological evaluations, hearing aids, supplies, visits for fitting, counseling, adjustments, repairs |
No co-payment |
| Eye Exams/Supplies |
Refractions to determine the need for corrective lenses; dilated retinal eye exams; eye glass frames and lenses, cataract spectacles and lenses |
No co-payment |
Accessibility Statement