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Public program for low income people
Medicare and Medi-Cal benefits
Medicare plan for chronic care needs
CHG members impacted by the federal, state or county declared state of emergency will continue to have access to medically necessary services by:
• Contacting Member Services staff, who are available 24/7 and can coordinate with members, network providers, and subcontractors to ensure member has access to medically needed emergency care: 1-800-224-7766 (TTY users please call 1-855-266-4584 or 711)
• Contacting our Behavioral Health Services, available 24/7, who provide free access to resources, materials, and counseling services through its dedicated hotline: CHG’s Behavioral Health Services Department at 1-800-404-3332 or the County of San Diego Access & Crisis Line at 1-888-724-7240
• Extending filing deadlines for Grievances and requests for Appeals
• Coordinating, transferring, and referring members to alternate sources of care when Providers are closed, unable to meet the demands of a medical surge, or otherwise affected by an emergency
• Authorizing Members to replace durable medical equipment (DME) or medical supplies Out-of-Network
• Relaxing time limits for prior authorization, precertification, or referrals and not require prior authorization for emergency room care outlined in Utilization Management. Policy No. 7251.8a “Review of Requests for Health Care Services”
• CHG Care Managers conducting outreach to members in care and disease management programs in mandatory evacuation areas to ensure continuity of care
• CHG working with members who have been displaced may see appropriate out-of-network providers at in-network benefit levels and may replace medical equipment and supplies as needed
• CHG extending filing deadlines for claims and pay emergency room clean claims within 45 calendar days outlined in Claims; Policy No. 8811a “Emergent Care Claim Payment Criteria”
• For Cal-MediConnect members CHG allows immediate refill of prescriptions for members eligible under our prescription program (Cal MediConnect). “MedImpact Medicare Part D Emergency Preparedness Program Description”
• Members who may have lost or misplaced their identification card can print a new card from our website at www.chgsd.com.
**Effective January 1, 2022 pursuant to Governor’s executive order N-01019, Medi-Cal pharmacy benefits were transitioned from managed care plans (such as Community Health Group) to DHCS and the Medi-Cal Rx program.
Overview of CMS Guidance
After-hours care is when you need medical attention after your doctor's office is closed. If you need after-hours care, you can call:
CHG members who need help during a major disaster should call the Member Services Department at 1-800-224-7766 (TTY users please call 1-855-266-4584 or 711).
CHG encourages members to download and print the Member Preparedness Manual on the CHG website as a hard copy reference for key contact information in case of an emergency.
Medi-Cal Member Services
CommuniCare Advantage Member Services
Community y Más Member Services