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We are an authorized Enrollment Entity for the State of California Healthy Families and Medi-Cal for Children and Expectant Mothers, (EE - 85691). Though we are not a State Agency, we assist with the enrollment of children and expectant mothers in either the Healthy Families or Med-Cal Programs. As an authorized Enrollment Entity we provide live assistance with online enrollment in these government programs. This assistance is free of charge.

Children Health Plans in California Healthy Families

This chart lists all the health plans in Healthy Families. 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. Because of the size of this chart, you will need to use the left-right scroll bar at the bottom of your browser to see all the plans.

Once you have reviewed this material, click here to begin the California Healthy Families or Low-Cost Medi-Cal Application Form

 

Alameda Alliance for Health

 Blue Cross EPO Blue Cross HMO Blue Shield EPO Blue Shield HMO
Are all members required to have a
primary care physician (PCP)?		 Yes No Yes No Yes
Should a member get a referral from a PCP before going to a specialist? Yes No Yes No Yes
How many times can members change their PCP in one benefit year? 12 N/A Unlimited N/A 12
Does the plan offer a prescription drug mail-in program? No Yes Yes Yes Yes
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary? Yes Yes Yes No Yes
Does the plan provide the following optional benefits:
Biofeedback No Yes No No No
Acupuncture No Yes No No No
Chiropractic No Yes No No No
More than 20 outpatient alcohol and drug visits per benefit year Yes No No No No
Elective abortions Yes Yes Yes Yes Yes
Health Plan Statistics:
Total number of CA members** 95,505 2,041,032 2,340,121 1,218,251 1,313,677
What types of specialists are offered as PCPs in this plan?
General Practice Yes N/A Yes N/A Yes
Family Practice Yes N/A Yes N/A Yes
Pediatrician Yes N/A Yes N/A Yes
OB/GYN Yes N/A Yes N/A Yes
  Internal Medicine Yes N/A Yes N/A Yes
Other:
Quality Accreditations (NCQA/JCAHO)? No Yes Yes N/A NCQA
Type of Accreditation N/A Excellent
(Medicaid)		 Excellent
(Medicaid)		 N/A Commendable (Commercial Product)
Does the plan require its members to use Binding Arbitration to resolve    disputes?*** No Yes (excludes medical malpractice) Yes (excludes medical malpractice) No No
  Cat Optima Kids Care 1st Health Plan

Central Coast Alliance for Health

 Community Health Group (San Diego) Community Health Plan (Los Angeles)
Are all members required to have a
primary care physician (PCP)?		 Yes Yes Yes Yes Yes
Should a member get a referral from a PCP before going to a specialist? Yes Yes Yes Yes Yes
How many times can members change their PCP in one benefit year? 12 12 12 12 12
Does the plan offer a prescription drug mail-in program? No No No Yes Yes
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary? Yes Yes Yes Yes Yes
Does the plan provide the following optional benefits:
Biofeedback No No Yes No No
Acupuncture Yes No Yes Yes No
Chiropractic Yes No Yes Yes No
More than 20 outpatient alcohol and drug visits per benefit year No No No No No
Elective abortions Yes/No* Yes Yes Yes Yes
Health Plan Statistics:
Total number of CA members** 325,978 193,430 83,000 99,455 160,793
What types of specialists are offered as PCPs in this plan?
General Practice Yes Yes Yes Yes Yes
Family Practice Yes Yes Yes Yes Yes
Pediatrician Yes Yes Yes Yes Yes
OB/GYN Yes Yes Yes Yes Yes
  Internal Medicine Yes Yes Yes Yes Yes
Other:
Quality Accreditations (NCQA/JCAHO)? No No No NCQA No
Type of Accreditation N/A N/A N/A Commendable
(Medicaid)		 N/A
Does the plan require its members to use Binding Arbitration to resolve    disputes?*** No Yes (includes medical malpractice) No Yes (excludes medical malpractice) Yes (excludes medical malpractice)
  Contra Costa Health Plan Health Net HMO Health Net Life EPO

Health Plan of San Joaquin

 Health Plan of San Mateo
Are all members required to have a
primary care physician (PCP)?		 Yes Yes Yes Yes Yes
Should a member get a referral from a PCP before going to a specialist? Yes Yes Yes Yes Yes
How many times can members change their PCP in one benefit year? 12 12 12 12 12
Does the plan offer a prescription drug mail-in program? No Yes Yes Yes No
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary? Yes Yes Yes Yes Yes
Does the plan provide the following optional benefits:
Biofeedback Yes No No Yes Yes
Acupuncture Yes No No Yes Yes
Chiropractic Yes Yes Yes Yes Yes
More than 20 outpatient alcohol and drug visits per benefit year No No No No No
Elective abortions Yes Yes Yes Yes Yes
Health Plan Statistics:
Total number of CA members** 64,817 2,363,193 282,229 69,251 52,520
What types of specialists are offered as PCPs in this plan?
General Practice No Yes Yes Yes Yes
Family Practice Yes Yes Yes Yes Yes
Pediatrician Yes Yes Yes Yes Yes
OB/GYN Yes Yes Yes Yes Yes
  Internal Medicine Yes Yes Yes Yes Yes
Other:
Quality Accreditations (NCQA/JCAHO)? No NCQA No No No
Type of Accreditation N/A Excellent (Commercial Product) N/A N/A N/A
Does the plan require its members to use Binding Arbitration to resolve    disputes?*** No Yes (excludes medical malpractice) Yes (excludes medical malpractice) Yes (includes medical malpractice) No
  Inland Empire Health Plan Kaiser Permanente Kern Family Health Care LA Care
Health Plan		 Molina Healthcare
Are all members required to have a
primary care physician (PCP)?		 Yes Encouraged Yes Yes Yes
Should a member get a referral from a PCP before going to a specialist? Yes Yes Yes Yes Yes
How many times can members change their PCP in one benefit year? 12 Unlimited 12 12 12
Does the plan offer a prescription drug mail-in program? Yes Yes No Yes No
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary? Yes Yes Yes Yes Yes
Does the plan provide the following optional benefits:
Biofeedback No No No No No
Acupuncture No No Yes No Yes
Chiropractic No Yes Yes No Yes
More than 20 outpatient alcohol and drug visits per benefit year No Yes Yes Yes No
Elective abortions Yes Yes Yes Yes Yes
Health Plan Statistics:
Total number of CA members** 289,992 6,230,600 91,400 785,314 316,594
What types of specialists are offered as PCPs in this plan?
General Practice Yes Yes Yes Yes Yes
Family Practice Yes Yes Yes Yes Yes
Pediatrician Yes Yes Yes Yes Yes
OB/GYN Yes Yes Yes Yes Yes
  Internal Medicine Yes Yes Yes Yes Yes
Other:
Quality Accreditations (NCQA/JCAHO)? NCQA NCQA/ JCAHO No No NCQA
Type of Accreditation Commendable (Medicaid & HF Pgm product) †† N/A N/A Commendable (Medicaid)
Does the plan require its members to use Binding Arbitration to resolve    disputes?*** No Yes (includes medical malpractice) Yes (includes medical malpractice) Yes (includes medical malpractice) No
 

San Francisco Health Plan

 Santa Barbara Health Authority Santa Clara Family Health Plan Universal Care Ventura County Health Care Plan
Are all members required to have a
primary care physician (PCP)?		 Yes Yes Yes Yes Yes
Should a member get a referral from a PCP before going to a specialist? Yes Yes Yes Yes Yes
How many times can members change their PCP in one benefit year? Unlimited Unlimited 12 Unlimited 12
Does the plan offer a prescription drug mail-in program? No No No Yes Yes
Does the plan ask me to substitute generic for brand name drugs, except when medically necessary? Yes Yes Yes Yes Yes
Does the plan provide the following optional benefits:
Biofeedback Yes No Yes No No
Acupuncture Yes Yes Yes No No
Chiropractic Yes Yes Yes No No
More than 20 outpatient alcohol and drug visits per benefit year No Yes No No No
Elective abortions Yes Yes Yes Yes Yes
Health Plan Statistics:
Total number of CA members** 45,729 54,930 96,207 283,311 10,200
What types of specialists are offered as PCPs in this plan?
General Practice Yes Yes Yes Yes Yes
Family Practice Yes Yes Yes Yes Yes
Pediatrician Yes Yes Yes Yes Yes
OB/GYN Yes Yes Yes Yes Yes
  Internal Medicine Yes Yes Yes Yes Yes
Other:
Quality Accreditations (NCQA/JCAHO)? No No No NCQA No
Type of Accreditation N/A N/A N/A Commendable (Commercial Product) N/A
Does the plan require its members to use Binding Arbitration to resolve    disputes?*** Yes (excludes medical malpractice) No Yes (includes medical malpractice) Yes (includes medical malpractice) Yes (includes medical malpractice)

** This number represents the insurance plan's membership as of January 1, 2005.
*** To get additional information about each insurance plan's dispute resolution provisions, call th