Your Health Matters
Summer 2017, In This Issue:
- See a Doctor from Anywhere Using Your Phone or Computer
- Do you feel overwhelmed when trying to get health care?
- Our Quality Improvement (QI) Program
- Your Rights and Responsibilities
- Know Your Pharmacy Benefits
- Staying Safe in the Sun
- Our Staff Are Not Paid on the Decisions They Make About Your Health Care
- Need Help Managing Your Asthma or Diabetes?
- Tools to Manage Your Health
- Make an Appointment
- Changes have been made to the San Francisco Health Plan Medi-Cal,Healthy Workers HMO and Healthy Kids HMO pharmacy formularies.
- SF Benefits Net Enrollment Site
If you cannot reach your doctor, now you can talk to a doctor, day or night, using your phone or your computer from the comfort of your home.
With our new, FREE telemedicine service, Teladoc®, you can get care from a doctor for simple, non-emergency problems like colds, skin rashes, urinary problems, joint problems, and more.
Teladoc doctors are California Licensed and Board Certified. They are available anytime, 24 hours a day.
A Teladoc doctor can prescribe medications to treat your conditions and send it to your local pharmacy. However, Teladoc doctors cannot prescribe controlled substances, like narcotics.
Your PCP knows you best. Always attempt to reach them first for care (unless it is an emergency then dial 911). Before using Teladoc, you must register and complete a brief health history. The fastest and easiest way to complete your registration and health history is online at teladoc.com/sfhp. Call Teladoc at 1(800) 835-2362 for registration help.
You can schedule an appointment. Choose how to talk to the doctor. You can get more access to health care. It is FREE and the quality care you need with the convenience you want. Get started with Teladoc today!
*Teladoc is not available for our Kaiser Medi-Cal, Medi-Medi Part B or Medi-Medi Part AB members.
Do you feel overwhelmed when trying to get health care?
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 nurse to get ready for your next appointment.
- Work with your care team to better understand your medications.
Our Quality Improvement (QI) Program
Each year, we put together a QI plan for activities with our provider network, including your medical group and hospital, to improve your and all of our members’ health care. This QI plan and outcomes for meeting the QI plan goals are approved by the State Medi-Cal program, too. It is available to all Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members. If you are interested in the details for the QI plan or outcomes, you can find information on our website at sfhp.org/providers/qi-program-evaluations-results/ or request a paper copy by calling us at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Your Rights and Responsibilities
Medi-Cal, Healthy Kids HMO, and Healthy Workers HMO members have rights and responsibilities. We tell members their rights and responsibilities through SFHP materials like the SFHP Evidence of Coverage and Member Handbook. These materials list your responsibilities and rights.
We also post them online at sfhp.org/members.
Contact our Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free) for any questions or requests regarding member rights and responsibilities.
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 Evidence of Coverage, 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).
Staying Safe In the Sun
You should always wear sunscreen when out in the sun, even if it is not bright and sunny. After about 15 minutes in the sun without sunscreen, harmful ultraviolet (UV) rays can begin to damage your skin. UV rays from the sun are strong. They can go through clouds and can even bounce off water, sidewalks, buildings, sand, and snow. To protect yourself from these dangerous UV rays, wear sunscreen. Choose products that have UVA and UVB protection of SPF 15 or higher. Remember to put more sunscreen on after two hours of being in the sun. You should also put more sunscreen on after you swim or if you have been sweating.
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, call 1(415) 547-7830 or 1(888) 883-7347 (TDD), Monday – Friday, from 8:30am to 5:30pm. Linguistic services are available 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.
Need Help Managing your Asthma or Diabetes?
We offer two, no-cost disease management programs for Medi-Cal, Healthy Kids HMO and Healthy Workers HMO members:
- SFHP Asthma Care Program
- SFHP Diabetes Care Program
These programs help you if you have asthma or diabetes. If you qualify, you are automatically enrolled in these programs. You may stop at any time. For more information, please call us at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
Tools to Manage Your Health
We now have a member portal called SFHP HealthLink for all of our Medi-Cal members. In the portal are tools to help you manage your health.
These tools can help with:
- Healthy weight (BMI) maintenance
- Smoking and tobacco use cessation
- Encouraging physical activity
- Healthy eating
- Managing stress
- Avoiding at-risk drinking
- Identifying depressive symptoms
Sign up for SFHP HealthLink today, at sfhp.org and start managing your health with these online tools. For a printed copy of these tools, call our Customer Service at 1(415) 547-7800 or 1(800) 288-5555 (toll-free).
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 can not access the internet or have any questions about which medicines are covered, please call Customer Service at
1(800) 288‑5555 or 1(415) 547‑7800.
SF Benefits Net Enrollment Site