Benefits

Enjoy Options With CalOptima Health OneCare Complete (HMO D-SNP), a Medicare Medi-Cal Plan or CalOptima Health OneCare Flex Plus (HMO D-SNP), a Medicare Medi-Cal Plan

Choose from 1 of our 2 CalOptima Health OneCare options to get full health care at no extra cost. Our OneCare Complete plan offers support to fit your needs, while our OneCare Flex Plus plan enhances your care with more flexible benefits. Both options bring your Medicare and Medi-Cal benefits together, so you can focus on what’s most important — your health.

The OneCare Complete and OneCare Flex Plus Member Handbooks have a complete list of benefits.

*The CalOptima Health OneCare Flex Plus grocery benefit is part of a special supplemental program for the chronically ill. Not all members qualify. To use the grocery benefit, CalOptima Health OneCare Flex Plus members must have one or more comorbid and medically complex chronic conditions that are life threatening or significantly limits the overall health or function of the enrollee. Eligible conditions include but are not limited to cardiovascular disorder, diabetes mellitus, chronic heart failure, chronic lung disease, or end-stage renal disease. Even if the member has a chronic condition, the member will not necessarily receive the grocery benefit. Receiving the grocery benefit depends on the member having a high risk of hospitalization or other adverse health outcomes and a need for intensive care coordination.

**For a full list of services covered by Medi-Cal Dental, call 1-800-322-6384 (TTY 1-800-735-2922) or visit Smile, California. These resources can also help you locate a Medi-Cal dental provider and file a grievance or complaint.

Dental Care: Preventive and restorative dental services are provided through Medi-Cal. For benefits or to find a dentist, call Medi-Cal at 1-800-322-6384 or visit www.dental.dhcs.ca.gov.

Most services will be provided by our network providers. If you need a covered service that cannot be provided within our network, OneCare (HMO D-SNP) will pay for the cost of an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider, when necessary. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for a period of time if he or she agrees to work with OneCare.

If you need emergency care at any time, 24 hours a day, 7 days a week, you don’t need to get approval first. OneCare can provide you with a list of services or procedures that require you to obtain prior authorization before the service is provided.

If the Governor of California, the U.S. Secretary of Health and Human Services or the President of the United States declares a state of disaster or public health emergency in Orange County, you are still entitled to care from OneCare.

Most services will take place within our network of providers. If you need a covered service that cannot be provided within our network, OneCare will pay for the cost of an out-of-network provider. You have the right to see an out-of-network urgent or emergency care provider. If your current Medi-Cal or Medicare provider is not in our network, you can keep seeing that provider for a period of time if they agree to work with OneCare.

During a declared disaster or public health emergency, if you cannot use a network provider, we will allow you to get care from out-of-network providers at no cost to you. If you cannot use a network pharmacy during a declared disaster or public health emergency, you will be able to fill your prescription drugs at an out-of-network pharmacy.