What is SFHP Care Plus?
At SFHP, we believe every person deserves access to affordable, quality health care.
To advance our mission of improving health outcomes for vulnerable populations, SFHP introduced SFHP Care Plus — a Medicare Advantage Dual Special Needs Plan (D-SNP) designed specifically for San Franciscans who qualify for both Medicare and Medi-Cal. This exclusively aligned D-SNP plan delivers comprehensive, person-centered care through specialized benefits, enhanced care coordination, and a tailored provider network—ensuring that our members receive the right care, at the right time, in the right setting.
SFHP Care Plus makes it easier for dual eligible patients to stay healthy.
SFHP Care Plus members get:
- Coordinated Medicare and Medi-Cal benefits
- Prescription drug coverage
- Personalized care and support
- Extra benefits and services at no cost
Thank you for your collaboration as we work together to offer excellent, coordinated care for San Francisco’s dual eligible population.
If you have questions, please contact your Provider Relations representative. If you’re unsure who your PR rep is, you can email [email protected].
Who We Serve
SFHP Care Plus is designed to support a diverse group of San Franciscans who face complex health challenges.
Our members include individuals living with:
- Multiple chronic conditions
- Mental health conditions
- Cognitive impairments, such as dementia or developmental disabilities
- Physical disabilities
We are committed to delivering compassionate, coordinated care that meets the unique needs of each person we serve.
D-SNP Network & Benefits
SFHP and NEMS have partnered to support SFHP Care Plus (HMO D-SNP) members. NEMS has a dedicated SFHP Care Plus focus with a high-touch approach for managing complex patients. Through this partnership, NEMS will simplify care and enhance the member experience by coordinating Medicare and Medi-Cal benefits in a member-centric way. NEMS brings knowledge and experience in care management of D-SNP populations, provider engagement, and community-based support.
Clinical Practice Group (CPG), NEMS Medical Group, and Sutter
Zuckerburg San Francisco General Hospital (ZSFG)
California Pacific Medical Center (CPMC)
- Medical Group- North East Medical Center (NEMS)
- Carelon Behavioral Health
- Dental – Liberty Dental
- Vision – Vision Service Plan (VSP)
- Hearing – North East Medical Center (NEMS), University of the Pacific (UOP)
- Chiropractic and Acupuncture – American Specialty Health (ASH)
- Hospital – ZSFG and CPMC
- Pharmacy/Pharmacy Benefit Manager (PBM) Medimpact
SFHP Care Plus (HMO D-SNP) covers all services that are covered by Original Medicare, plus prescription drugs and additional services and benefits (supplemental benefits) that are not covered by Original Medicare.
All SFHP Care Plus preventive benefits are covered in full and include but are not limited to:
- Annual Wellness Visits
- Colonoscopies
- Mammograms
- Bone density scans
- Prostate screenings
- Vaccines
Emergency care is covered and includes:
- Emergency room
- Urgent care
- Ambulance transportation (non-emergency transport is not covered)
Cost of Out-of-Network Care
Emergency care outside the network is covered only in the United States or its territories. Urgent care outside the network is covered if the member is outside our service area, or if it is not reasonable to use in-network care.
*No network requirements
Care Coordination
At SFHP, care coordination is the cornerstone of our SFHP Care Plus Model of Care. We are committed to ensuring that every member receives personalized, proactive, and integrated support—tailored to meet their unique health needs and life circumstances. Our approach fosters collaboration across providers, services, and systems to deliver seamless, compassionate care every step of the way.
Help SFHP Care Plus members get started with Care Coordination by working with the member, their caregiver, and their Case Manager to complete a Health Risk Assessment (HRA).
For more information about Care Coordination, take our training or contact your medical group.
Provider Training and Resources
Provider Training
All providers- whether in network or out of network- who routinely care for SFHP Care Plus members must complete annual MOC training.
SFHP uses Litmos, a Learning Management System, to track training completion and send timely reminders—helping ensure full compliance with required education.
To get started, contact your medical group or visit our Provider Training page to sign up for Litmos to begin your required training.
If you are unable to access Litmos or are not part of a medical group, the training is also available at the link below.
Provider Resources
For providers, SFHP Care Plus means a more coordinated approach to caring for your patients. We are dedicated to supporting you with the tools and information you need to give members the best care possible.
To get started, here are some resources: