California PHC

Using PHC California is easy. You will get most of your care from your primary care provider (PCP). Your PCP is listed on the front of your member ID card. If you are seeing a different PCP, contact Member Services. We will update our records and send you a new card.

You can change your PCP whenever you want. You can change for any reason. If you want to change your PCP, please contact Member Services.

If you need care from a specialist, your PCP will refer you. You may go to certain specialists for the services listed below without seeing your PCP first. Be sure to get these services from network providers.

• Routine women’s health care, which includes breast exams, screening mammograms (x-rays of the breast), pap tests and pelvic exams, as long as you get them from network women’s health providers like gynecologists
• Family planning services
• Prenatal/perinatal care and maternity services
• Vision care

If you have a medical emergency, call 911 or go to the closest hospital. You don’t need to use a network hospital if you have a medical emergency.

If you need urgent care when you are out of Los Angeles County, you may go to any urgent care center.

You generally must get your care from a network provider. In most cases, care you get from an out-of-network provider will not be covered. There are exceptions:

• The plan covers emergency care or urgent care that you get from an out-of-network provider or facility.
• If you need medical care that Medi-Cal requires us to cover and the providers in our network can’t provide it, you can get it from an out-of-network provider. You must have an authorization (approval) from us prior to getting care from an out-of-network provider.

You can see the plan’s covered services. More detail about how to use the plan is in the Member Handbook (effective January 1, 2020).

You can find network providers and facilities, like hospitals. Go to Network Provider, Facility and Pharmacy Search.

If we made a coverage decision about a service you want to get or already got and you don’t like it, you can appeal.

If you have questions, contact Member Services. We are here to help.

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.

The benefit information provided is a brief summary, not a complete description of benefits. Limitations and restrictions apply. Benefits, formulary, and/or pharmacy network may change.