SFHP Care Plus Benefits & Covered Services for Your Health Needs
With SFHP Care Plus, there are no monthly premiums or deductibles. SFHP Care Plus brings your Medicare and Medi-Cal benefits and services together and adds FREE extra benefits.
As a member, our team will help you fully understand your coverage and make sure you get the most out of your plan. With just one card and one phone number, you get the care and support you need.
Summary of Benefits
Our extra supplemental benefits are offered to help keep you healthy.
Use our Provider Directory to see which doctors and specialists are in the SFHP Care Plus network.
- $0 copay and $0 deductible for doctor and hospital visits
Find network pharmacies, check covered medications, and learn how SFHP Care Plus helps you get the prescriptions you need: sfhp.org/careplus-pharmacy.
- $0 copay for preferred generic and select covered drugs to manage chronic conditions such as high blood pressure and diabetes
- Low copays will apply to other covered generic and brand-name drugs
The SFHP Care Plus &more™ Card gives you $150 every three months to spend on approved health items like aspirin, vitamins, cold medicine, bandages, and more. Learn how the card works, what products are covered, and where you can shop: sfhp.org/OTC_Catalog
- $150/quarter for select over-the-counter products
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Items covered under this benefit include:
- Aspirin
- Vitamins
- Cold and cough medicine
- Bandages
- And more
Dental services are available through Liberty Dental and Medi-Cal Dental 1(888) 704-9838 (TTY 711) or visit libertydentalplan.com. For a full list of services covered by Medi-Cal Dental, call 1(800) 322-6384 (TTY 1(800) 735-2922) or visit smilecalifornia.org.
- $0 cost for routine dental check-ups, including cleanings and x-rays
- $0 cost for denture rebase and crowns
- Extra services may be covered under Medi-Cal Dental
Eye care is available through VSP Vision Care providers in the “Advantage” Network. Visit vsp.com/advantageretail to learn more.
- $0 annual routine eye exam
- $300 for combined frames/lenses or contact lenses each year
Hearing care is available through local partners: North East Medical Services (NEMS), University of the Pacific Audiology and Hearing and Low Vision Solutions.
- $0 annual routine hearing exam
- Evaluations and fitting for hearing aids
- Up to $2,000 for hearing aids for both ears combined every year
Acupuncture and chiropractic care are available through our partnership with American Specialty Health (ASH). See provider options at sfhp.org/careplus-ash.
- $0 copay for up to 24 acupuncture visits per year
Acupuncture and chiropractic care are available through our partnership with American Specialty Health (ASH). See provider options at sfhp.org/careplus-ash.
- $0 copay for up to 12 chiropractic visits per year
For eligible members, the SFHP Care Plus &more™ Card includes monthly allowances for healthy food/groceries and rent/utilities. This program also covers 24 one-way trips to non-medical locations. Call SFHP Care Plus Customer Service to learn more about eligibility.
- $20/month for heathy foods/groceries per year
- $20/month for utilities (electric, water, heating, etc.)
- 24 one-way trips (church, recreation centers, grocery store, etc.)
*Use your SFHP Care Plus Card at stores that accept it, or order online for home delivery.
**The SSBCI benefits are part of an additional program for the chronically ill. Not all members qualify.
Costs for In-Network Provider Services*
Our plan covers a yearly wellness visit to improve your care plan to help prevent illness. We pay for this once every 12 months.
We offer all preventive services covered by Medi-Cal or Medicare Parts A and B, such as flu shots and cancer screenings. Make sure you get your yearly wellness visit scheduled today.
Prior authorization rules may apply. Contact us for details.
Our plan covers 90 days for an inpatient hospital stay. Our plan also covers 60 “lifetime reserve days.” These are “extra” days that we cover.
Prior authorization rules may apply.
- No copay for preferred generic and select covered drugs to manage chronic conditions such as high blood pressure and diabetes
- With Medicare’s Extra Help program, low copays for generic and brand drugs
- Easy access to drugs through network pharmacies or delivered to home
Our plan has a list of covered drugs called the “drug list” for short. It tells you which prescription drugs our plan covers. These include drugs that your provider orders for you and that you get from a pharmacy. View our drug formulary to see our full drug list
- Emergency room visits
- Urgent care
- Ambulance transportation (non-emergent transport is not covered)
*Most services will be provided by our network providers. If you need a service that cannot be provided within our network, SFHP Care Plus will pay for the cost of an out-of-network provider.
Costs for Out-of-network care
Emergency care outside your network is covered only in the United States or its territories.
Urgent care outside your network is covered if you’re outside our service area or if it’s not reasonable to use in-network care.
Outpatient mental or behavioral health services include, but are not limited to the following:
- Individual and group mental health evaluation and treatment
- Intensive Outpatient Program (IOP) services
- Partial Hospitalization Program (PHP) services
- Psychological testing to evaluate mental health condition, and more
For questions about behavioral health call SFHP Care Plus Customer Service at
- Diagnostic radiology services (X-rays or other imaging services, such as CAT scans or MRIs)
- Lab tests
- Diagnostic procedures (such as blood work)
Prior authorization rules may apply. Contact us for details.
- Screening, Assessment, Brief Intervention and Referral to Treatment (SABIRT)
- Opioid Treatment Program (OTP) services
For questions about behavioral health call SFHP Care Plus Customer Service at
- Physical therapy
- Occupational therapy
- Speech language therapy
Outpatient rehabilitation services are provided in multiple outpatient settings, such as:
- Hospital outpatient departments
- Independent therapist offices
- Comprehensive Outpatient Rehabilitation Facilities (CORFs)
Prior authorization rules may apply.
- Diagnosis and medical or surgical treatment of injuries and diseases of the foot (such as hammer toe or heel spurs)
- Routine foot care for members with conditions impacting the legs, such as diabetes
Prior authorization rules may apply.
We cover all medically necessary DME that is typically covered by Medicare and Medi-Cal. This includes, but is not limited to, wheelchairs (including electric wheelchairs), crutches, and other approved items.
Prior authorization rules may apply.
Prior authorization is not required for dialysis services received in network. Prior authorization is required for out of network dialysis services.
You can talk to a nurse 24/7 for help with non-emergency care.
Speak with one of our SFHP Care Plus Medicare Specialists to get your questions answered.
You can fill out an online form or call us to make an appointment:
October–December: Seven days a week,
January–September: Monday, Tuesday, Thursday, and Friday,