Santa Clara Family Health Plan

Santa Clara Family Health Plan Insurance Review

Brief Introduction and Overview of the Company

Santa Clara Family Health Plan (SCFHP) is a community-based health plan deeply committed to enhancing the health and well-being of Santa Clara County residents. Established in 1997, SCFHP provides crucial access to healthcare through Medi-Cal and Cal MediConnect (a Medicare-Medicaid Plan), addressing the healthcare needs of individuals and families lacking access to affordable options. SCFHP’s dedication to culturally sensitive and comprehensive care sets it apart in the community.

Key Highlights of the Company’s Market Position and Reputation

• Mission and Vision: SCFHP's core mission is to improve the well-being of its members by proactively addressing their health and social needs, employing a culturally responsive approach. Its vision is to cultivate a just and equitable community where everyone has equal opportunities to achieve optimal health.
• Community Focus: SCFHP actively collaborates with healthcare providers and community organizations to ensure the delivery of high-quality healthcare services. The plan's commitment to integrity, exceptional service, and unwavering community support forms the cornerstone of its operations.
• Accreditation and Recognition: SCFHP boasts numerous accolades, including NCQA Accreditation for its Cal MediConnect services and several awards recognizing its innovative approaches to healthcare and exceptional quality improvement initiatives.

Overview

Year of Establishment and Background Story

SCFHP's journey began in 1997, welcoming its first member in February of that year. Since its inception, the organization has experienced remarkable growth, now serving over 320,000 individuals through its Medi-Cal and SCFHP DualConnect (HMO D-SNP) health plans. This sustained growth reflects the organization’s effectiveness and responsiveness to community needs.

Key Milestones in the Company’s History and Growth

SCFHP's history is marked by a series of significant milestones that demonstrate its commitment to innovation and community impact. These include:

• 2001: Received the South Bay AFL-CIO Labor Council COPE Award for "Innovations in Health Care."
• 2003: Awarded by the National Hispanic Medical Association.
• 2007: Launched Healthy Generations (Medicare Advantage Special Needs plan) and a positive evaluation of the Healthy Kids Program highlighted its impact on children's health and parental well-being.
• 2010: Launched Healthy Workers, a pilot program aimed at providing affordable health coverage for small businesses with lower-wage employees.
• 2012: Selected for California's Coordinated Care Initiative, with Santa Clara County residents approving Measure A to fund the Healthy Kids Program.
• 2013: Membership exceeded 150,000, and the Santa Clara Family Health Foundation gained independence.
• 2014: Welcomed adults from Valley Care's LIHP, transitioning to Medi-Cal under the Affordable Care Act. Integrated long-term services and supports into its Medi-Cal managed care plan.
• 2015: Launched Cal MediConnect and received recognition as a top 50 small call center in North America. Also received the California Department of Health Care Services 2015 Outstanding Performance Award.
• 2016: Expanded Medi-Cal coverage to children regardless of immigration status.
• 2017: Celebrated its 20th anniversary and received the 2017 award for Greatest Improvement in Quality Strategy Focus Areas.
• 2019: Achieved three-year NCQA Accreditation for Cal MediConnect and launched the Health Homes program.

Regulatory Compliance and Licenses

Details on Licenses and Certifications Obtained

• NCQA Accreditation: SCFHP holds NCQA Accreditation for its Cal MediConnect line of business, demonstrating its commitment to meeting rigorous quality assurance standards.
• Benchmark Portal Certification: Recognized by Benchmark Portal as a Center of Excellence, highlighting its dedication to exceptional customer service and support.

Insurance Products and Services

Main Insurance Products

• Medi-Cal: SCFHP offers Medi-Cal, a vital health insurance program for low-income individuals and families in Santa Clara County.
• Cal MediConnect: SCFHP also provides Cal MediConnect, a comprehensive Medicare-Medicaid Plan catering to individuals eligible for both Medicare and Medi-Cal.

Additional Services

• Health Homes Program: This program simplifies healthcare coordination for members and connects them with community resources addressing needs beyond healthcare, such as food security and housing assistance.
• Quality Improvement Initiatives: SCFHP leverages advanced platforms like CitiusTech’s SCORE+ to optimize HEDIS compliance and thoroughly evaluate performance against NCQA HEDIS and Medi-Cal benchmarks.

Premiums and Pricing

Pricing Structure

SCFHP's pricing structure varies depending on the specific plan (Medi-Cal or Cal MediConnect) and individual eligibility. Precise premium rates are not publicly listed on the SCFHP website. Potential members should contact SCFHP directly for detailed pricing information.

Comparative Analysis with Industry Averages

A direct comparison of SCFHP's premium rates to industry averages is not readily available through official channels.

Discounts and Special Offers

Currently, no information regarding discounts or promotional offers is available on the SCFHP website. It's advisable to contact SCFHP to inquire about potential discounts.

Customer Service and Support

Contact Methods

SCFHP provides customer support through phone (408-376-2000) and email. However, a live chat option is not currently offered on the website.

Availability of 24/7 Support and Multilingual Assistance

The availability of 24/7 support and multilingual assistance is not explicitly detailed on the SCFHP website. It's recommended to contact SCFHP to clarify these details.

Pros and Cons of Santa Clara Family Health Plan Insurance

Pros

• Comprehensive Coverage: SCFHP provides comprehensive healthcare coverage through its Medi-Cal and Cal MediConnect plans, offering a wide range of healthcare services.
• Community Focus: The plan's dedication to community well-being is a major strength, fostering partnerships with local providers and organizations to deliver high-quality, accessible care.
• Regulatory Compliance: SCFHP's adherence to standards like NCQA Accreditation reassures members of the quality and integrity of its services.

Cons

• Limited Information on Premiums: The lack of transparent premium information online may be a drawback for those seeking upfront cost comparisons.
• No Live Chat Support: The absence of a live chat option might be inconvenient for some members preferring immediate online communication.

Conclusion

Summary of the Main Points Covered in the Review

SCFHP is a community-centered health plan committed to improving the health of Santa Clara County residents. It offers comprehensive Medi-Cal and Cal MediConnect plans, and has earned recognition for its quality improvements and community focus. However, greater transparency on pricing and the addition of live chat support could enhance the member experience.

Recommendations on Who Would Benefit Most from the Company’s Insurance Offerings

SCFHP's insurance offerings are ideally suited for Santa Clara County residents eligible for Medi-Cal or Cal MediConnect. Individuals who value comprehensive coverage and a strong community-focused approach to healthcare would find SCFHP a beneficial choice.

Frequently Asked Questions about Santa Clara Family Health Plan Insurance

Answers to Common Questions about the Company’s Policies, Claims Process, and More

1. When was Santa Clara Family Health Plan founded? SCFHP was founded in 1997.
2. Where is Santa Clara Family Health Plan’s headquarters located? The headquarters is located at 6201 San Ignacio Ave, San Jose, CA 95119.
3. What types of insurance does Santa Clara Family Health Plan offer? SCFHP offers Medi-Cal and Cal MediConnect (Medicare-Medicaid Plan).
4. How does Santa Clara Family Health Plan ensure quality healthcare services? SCFHP ensures quality through provider partnerships, community collaborations, and adherence to accreditation standards like NCQA Accreditation.
5. What additional services does Santa Clara Family Health Plan provide? SCFHP provides services like the Health Homes Program, connecting members with healthcare coordination and community resources.

References

• [1] https://www.scfhp.com/about-us/
• [2] https://www.healthplanalliance.org/assnfe/cv.asp?ID=43
• [3] https://leadiq.com/c/santa-clara-family-health-plan/5a1d9b512300005a008ab055
• [4] https://www.scfhp.com/about-us/our-history/
• [5] https://www.cbinsights.com/company/santa-clara-family-health-plan