STAGE DEV MAY, 2013

Opal 25

Opal 25

CCHP Opal 25 Plan Benefit Highlights

tab01 opal-25

tab02 opal-25

2017 Benefit Highlights

  • Individual $1,500 / Family $3,000 Annual Deductible
  • $0 Copay for Preventive Services
  • $0 Copay for Lab Tests & X-Rays (After Deductible)
  • $0 Copay for Maternity Care (Preconception/Prenatal/Postnatal Care)
  • $0 Copay for the First 3 Primary Care Physician Visit
  • Maximum out-of-pocket: Individual $4,000/ Family $8,000

Plan Benefit Highlights

Pediatric Dental Summary

Pediatric Vision Summary

Optional Riders:
Adult Vision Summary (B)
Adult Vision Summary (C)
Chiropractic Summary

Employer Group Plans Rate - San Francisco County

Employer Group Plans Rate - Northern San Mateo County

Summary of Benefits (SBC)

Health Plan Benefits and Coverage Matrix

Evidence of Coverage (EOC)

CCHP Provider Directory - HMO (English and Chinese)
To start an online Provider Search, click here

CCHP Pharmacy Directory (English)

List of Covered Drugs (Formulary) (English) * (No changes made since 11/2017)

Formulary Changes for 2017 (English)

* There are four tiers in the drug formulary. Tiers include the types of drugs that are covered. Please refer to your Evidence of Coverage and Disclosure Form for details.

Tier Definition
1 1) Most generic drugs and low cost preferred brands.
2 1) Non-preferred generic drugs or;
2) Preferred brand name drugs or;
3) Recommended by the plan's pharmaceutical and therapeutics (P&T) committee based on drug safety, efficacy and cost.
3
 
1) Non-preferred brand name drugs or;
2) Recommended by P&T committee based on drug safety, efficacy and cost or;
3) Generally have a preferred and often less costly therapeutic alternative at a lower tier.
4

 

1) Food and Drug Administration (FDA) or drug manufacturer limits distribution to specialty pharmacies or;
2) Self administration requires training, clinical monitoring or;
3) Drug was manufactured using biotechnology or;
4) Plan cost (net of rebates) is >$600.

 

tab03 opal-25

2016 Benefit Highlights

  • Individual $1,500 / Family $3,000 Annual Deductible
  • $0 Copay for Preventive Services
  • $0 Copay for Lab Tests & X-Rays (After Deductible)
  • $0 Copay for Maternity Care (Preconception/Prenatal/Postnatal Care)
  • $0 Copay for the First 3 Primary Care Physician Visit
  • Maximum out-of-pocket: Individual $4,000/ Family $8,000

Plan Benefit Highlights

Pediatric Dental Summary

Pediatric Vision Summary

Optional Riders:
Adult Vision Summary (B)
Adult Vision Summary (C)
Chiropractic Summary

Employer Group Plans Rate - San Francisco County

Employer Group Plans Rate - Northern San Mateo County

Summary of Benefits (SBC)

Health Plan Benefits and Coverage Matrix

Evidence of Coverage (EOC)

Provider Directory - HMO (English and Chinese)
To start an online Provider Search, click here

Pharmacy Directory (English)

List of Covered Drugs (Formulary) (English) * (No changes made since 12/2016)

Formulary Changes for 2016 (English)

* There are four tiers in the drug formulary. Tiers include the types of drugs that are covered. Please refer to your Evidence of Coverage and Disclosure Form for details.

Tier Definition
1 1) Most generic drugs and low cost preferred brands.
2 1) Non-preferred generic drugs or;
2) Preferred brand name drugs or;
3) Recommended by the plan's pharmaceutical and therapeutics (P&T) committee based on drug safety, efficacy and cost.
3
 
1) Non-preferred brand name drugs or;
2) Recommended by P&T committee based on drug safety, efficacy and cost or;
3) Generally have a preferred and often less costly therapeutic alternative at a lower tier.
4

 

1) Food and Drug Administration (FDA) or drug manufacturer limits distribution to specialty pharmacies or;
2) Self administration requires training, clinical monitoring or;
3) Drug was manufactured using biotechnology or;
4) Plan cost (net of rebates) is >$600.

 

CCHP Pharmaceutical Management Procedures (English)

VSP In-Network Provider Search / VSP Member Account Access
(By clicking on this link, you will leave CCHP's website.)
 

ASH Chiropractic Provider Search
(By clicking on this link, you will leave CCHP's website.)