Your Health Matters
Summer 2019, IN THIS EDITION:
- Who Should You Call?
- Choose a PCP for Your Adult Care
- Member Incentive Programs Available!
- Our Staff Are Not Paid on the Decisions They Make About Your Health Care
- Know Your Pharmacy Benefits
- Do You Need Help Talking To Your Doctor?
Who Should You Call?
As a member of San Francisco Health Plan, we want to make sure you get the care you need when you need it. We are your health plan. It is our job to connect you to all the health care services covered by your program. Here is who you should call when you need answers or help.
When you call our Customer Service team, they will speak to you in the language you prefer and take the time to answer all the questions you may have about your health care benefits and services.
Some of the things we can help you with are:
We can help you find a PCP. We can help you find the right doctor for your needs. If you want to change doctors, we are here for you.
We mail you your ID card, with vital contact information. If you lose your ID card, we can send you a new one. If you ever need any information or materials about your health care or SFHP, we can provide them to you.
We can help you sign up for our online Member Portal and walk you through all the information and benefits.
We will help you with your pharmacy needs. We can tell you what medicine and prescriptions are covered, including specialty medicine. We can give you the hours and locations of pharmacies.
If you are having an issue, we will work with you to fix the problem. If, together, we cannot resolve the problem, we can help you file a grievance.
Turning 18 brings more opportunities and more responsibilities. It can mean changing your school, your job, where you live, and how you handle your money. It also means taking a more active role in your health. When you turn 18, it’s time to choose a new primary care provider (PCP) who takes care of adults. You may be able to stay with your PCP if he or she is a family physician. But if you have been going to a pediatric clinic, you will need to switch to a PCP who works with adults. Talk to your PCP about your choices for transitioning to adult care. For more help in finding a PCP for adult care please call SFHP Customer Service at 1(415) 547-7800 (local) or 1(800) 288-5555 (toll-free), or for the hearing impaired, call 1(415) 547-7830 or 1(888) 883-7347 (TDD), Monday – Friday, from 8:30am to 5:30pm. Linguistic services are available, free of charge, for members requiring language assistance.
Member Incentive Programs Available!
SFHP Member Incentive Programs reward members for completing an activity related to improving their health.
SFHP currently has 7 incentive programs which include:
- Adult Wellness Visit
- Asthma (Asthma Control Test)
- Childhood Immunization
- Diabetes Screening
- Diabetes Eye Exam
- Hypertension (blood pressure check with PCP and Healthy Action Plan)
- Postpartum (Health Visit)
- Prenatal (Check Up)
- Well-Child Visits
SFHP receives incentive forms that have been signed by providers after the completion of the activity. Incentive forms are processed within 30 days of submission. Gift cards are given to members.
Members who have completed and submitted the incentive form but have not received a response within 5 weeks of submission may call SFHP Customer Service at 1(800) 288-5555 to make an inquiry.
Providers can fax your incentive forms directly back to SFHP at 1(415) 615-4547.
Our Staff Are Not Paid on the Decisions They Make About Your Health Care
SFHP does not compensate or give incentives based on coverage review decisions by our Utilization Management (UM) staff, nurses, physicians, our medical groups, or our independent medical consultants.
We do not reward or provide financial incentives to anyone performing utilization review services for issuing denials of coverage.
We do not give financial incentives to encourage utilization review decisions that result in underutilization. We make UM decisions based only on appropriateness of care and service and existence of coverage.
If you have any questions regarding utilization review, please call Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free), or for the hearing impaired, call1(415) 547-7830 or 1(888) 883-7347 (TDD), Monday – Friday, from 8:30am to 5:30pm. Linguistic services are available, free of charge, to Medi-Cal, Healthy Kids HMO, and Healthy Workers HMO members requiring language assistance.
After business hours, UM staff can receive secure voicemail, fax, and email. UM staff will respond to messages the next business day. If the message is received after midnight Monday through Friday, the staff will respond the same business day.
Know Your Pharmacy Benefits
If you need medicines, your doctor will prescribe them to you.
At your visit, let your doctor know which network pharmacy you want to pick up your medicines.
To get your medicines show your SFHP Member ID Card to the pharmacy staff.
Medi-Cal members do not pay money for medicines covered under their pharmacy benefit.
At sfhp.org, you can find more information about your pharmacy benefit. You can view the most up-to-date San Francisco Health Plan formulary and see if your medication is in it. You can see if your medication needs prior authorization, step therapy, or if it is given by a specialty pharmacy. You can find answers to common questions and search for a pharmacy.
Click on the Summary of Benefits in your Member Handbook, to review your pharmacy benefit. If you cannot use the internet or have any questions about which medicines are covered, please call Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Do You Need Help Talking To Your Doctor?
Our Care Management programs can assist you on your journey to better health.
We work with our members both in person and over the phone to assess their needs and create a personal care plan. If you feel you or a family member would benefit from this service, please call us at 1(415) 615-4515.
This service is FREE for Medi-Cal, Healthy Kids HMO, and Healthy Workers HMO members.
In our programs, you can:
- Learn how to manage your medical conditions.
- Get referrals for community agencies; including food and behavioral health.
- Work with our team to get ready for your next appointment.
- Work with your care team to better understand your medications.
Make an Appointment
Our Service Center can help you fill out and submit your Medi‑Cal application. Call Customer Service at 1(415) 777‑9992 to get started. The Human Services Agency determines who qualifies for the Medi‑Cal Program.
Changes have been made to the San Francisco Health Plan Medi‑Cal, Healthy Workers HMO and Healthy Kids HMO pharmacy formularies.
To view our most recent updates, please go to sfhp.org. If you cannot access the internet or have any questions about which medicines are covered, please call Customer Service at 1(415) 547‑7800 or 1(800) 288‑5555 (toll-free).
SF Benefits Net Enrollment Site
Find out if you are eligible for Medi-Cal, Food Stamps, School Meals, and other benefits.
1440 Harrison St.
Monday – Friday
8:00am to 5:00pm
Call SF BenefitsNet at 1(855) 355-5757.