Your Benefits

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Questions




If you have questions or need help with your health care, please call our Customer Service Department at:

1-855-705-8823 (toll free)

24 hours a day/ 7 days a week.

Members with hearing or speech impairments can call our TDD/TTY line at 1-800-735-2929.

We also provide interpreter services at no cost to our members.

We have staff who speak your language.

Tenemos personal que habla su idioma.

Chúng tôi có nhân viên nói cùng ngôn ngữ với quý vị

ما پرسنلی را در استخدام داریم که به زبان شما تکلم می کنند.

여러분의 언어를 하는 직원이 있습니다.

Covered Benefits (2018)

With OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan), your Medicare and Medi-Cal benefits are provided in a single plan, making it easier for you to get health care services. At no extra cost, you also get vision care and transportation to medical appointments.

OneCare Connect coverage includes:

  • Doctor and specialist visits

  • Hospital care and surgeries

  • Medical tests and screenings

  • Emergency and urgent care

  • Prescription medications (co-pays of $0 to $8.35 apply for certain drugs)

  • Basic dental services from Denti-Cal, plus supplemental dental benefits

  • Physical and occupational therapy

  • Vision care ($100 frames/lenses or $100 contacts, every two years)

  • Basic mental health services and help getting specialty mental health services, including substance use disorder services

  • Medical equipment and supplies

  • Certain home and community services (Community-Based Adult Services, In-Home Supportive Services and Multipurpose Senior Services Program)

  • Long-term care in nursing homes

There is no cost to you for the above services, except prescription medications. For up to a 90-day supply, your co-payment for a formulary generic drug is $1.25 or $3.35. Your co-payment for a formulary brand-name drug is $3.70 or $8.35. Your co-pay is $0 when your total out-of-pocket costs exceed $5,000 annually. See our Summary of Benefits and Member Handbook for more information on OneCare Connect's coverage.

Covered Benefits (2019)

Out-of-Network Coverage

Most services will be provided by our network providers. If you need a covered service that cannot be provided within our network, OneCare Connect 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 Connect.

Emergency Services Coverage

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 Connect can provide you with a list of services or procedures that require you to obtain prior authorization before the service is provided.

New Member Orientations

To learn more about OneCare Connect, you can attend one of our Member Orientation meetings. At this meeting, you will learn:

  • How to get an authorization for your medication

  • How to use community resources

  • How to get medical services

  • About your member rights and responsibilities

To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H8016_19MM027_M Accepted (09/25/18)

OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations, co-pays, and restrictions may apply. For more information, call OneCare Connect Customer Service or read the OneCare Connect Member Handbook. Benefits and/or copayments may change on January 1 of each year. Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details. Other Pharmacies/Physicians/Providers are available in our network. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. OneCare Connect complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. You can get this information for free in other languages. Call toll-free 1-855-705-8823. TDD/TTY users can call 1-800-735-2929. The call is free.

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