Healthy Families Health Plans

Health Plans

This chart lists the health plans in your county. The chart answers common questions about the plans. Information about each plan was provided by the plan. Click on each plan name for a description of the plan.

Santa Cruz County
.	Central Coast Alliance for Health	Blue Cross EPO	Blue Shield HMO	Health Net HMO
Are all members required to have a primary care physician (PCP)?	Yes	No	Yes	Yes
Should a member get a referral from a PCP before going to a specialist?	Yes	No	Yes	Yes
How many times can members change their PCP in one benefit year?	12	N/A	12	12
Does the plan offer a prescription drug mail-in program?	No	Yes	Yes	Yes
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary?	Yes	Yes	Yes	Yes
Does the plan provide the following optional benefits:
Biofeedback	Yes	Yes	No	No
Acupuncture	Yes	Yes	No	No
Chiropractic	Yes	Yes	No	Yes
More than 20 outpatient alcohol and drug visits per benefit year	No	No	No	No
Elective abortions	Yes	Yes	Yes	Yes
Health Plan Statistics:
Total number of CA members*	83,000	1,984,756	1,226,423	2,251,969
What types of specialists are offered as PCPs in this plan?
General Practice	Yes	N/A	Yes	Yes
Family Practice	Yes	N/A	Yes	Yes
Pediatrician	Yes	N/A	Yes	Yes
OB/GYN	Yes	N/A	Yes	Yes
Internal Medicine	Yes	N/A	Yes	Yes
Other:
Quality Accreditations (NCQA/JCAHO)?	No	NCQA	NCQA	NCQA
Type of Accreditation	N/A	Excellent (Medicaid)	Excellent for service and clinical quality	Excellent (Commercial Product)
Does the plan require its members to use Binding Arbitration to resolve disputes?**	No	Yes (includes medical malpractice)	No	Yes (includes medical malpractice)

* This number represents the insurance plan's membership as of January 1, 2007.

** To get additional information about each insurance plan's dispute resolution provisions, call the plan or refer to the plan's Disclosure Form and Evidence of Coverage booklet, which is available upon request from each health plan.

NOTE: These summaries are for information only. This is not a contract. For a detailed and precise statement of benefits and exclusions, please refer to you Evidence of Coverage/Certificate of Insurance.