Periodically, Valley Health Plan will be sending you Member Updates to provide you with important benefit information, changes in policy or new state regulations. Please keep these updates with your VHP Evidence of Coverage & Disclosure Form (EOC) booklet. These Member Updates along with articles in the Perspectives Newsletter will be your notification of changes related to your contract with Valley Health Plan (VHP).
You can now subscribe to VHP Online to receive emails about Member updates and news.
Issue 3 | May 2013
Custom Fabricated Oral Devices or Appliances Benefit
This is an official notification from Valley Health Plan (VHP) clarifying the Custom Fabricated Oral Devices or Appliances benefit. This benefit addresses the treatment of Obstructive Sleep Apnea (OSA) and other medical conditions for which the oral device or appliance has proven efficacy. VHP does not cover Custom Fabricated Oral Devices or Appliances as under the Durable Medical Equipment benefit.
Effective August 1, 2013, VHP will pay for medically-necessary, custom-fabricated oral devices or appliances to treat OSA, and other medical conditions for which the oral device or appliance has proven efficacy. These are not simple “mouth guards” or “night guards,” formally known as occlusal splints, but devices that reposition the jaw. Lifetime benefit maximum is $1290 for all aspects related to producing and fitting the device, including, but not limited to, the taking of impressions, modeling, fabricating, and fitting and readjustment of the device or appliance up to 90 days after the initial fitting. The appliance or device must be FDA-approved for the condition. The VHP medical insurance is secondary to any dental insurance coverage you may have that provides coverage for any part of the production, fitting, and adjusting of the device. Explanation of benefits or denials from your dental insurance carrier must accompany receipts for which you seek reimbursement. VHP will not pay for occlusal splints.
If you have any questions regarding this benefit clarification, please contact Member Services Monday through Friday, 9am to 5pm at 408.885.4760 or 1.888.421.8444 (toll-free).
Issue 2 | September 2011
Effective, November 1, 2011, Valley Health Plan (VHP) is introducing Navitus Health Solutions, your new prescription drug benefit manager. You will continue to enjoy a $0 co-pay prescription benefit. Navitus Health Solutions offers you benefits such as a designated 24/7 Pharmacy Customer Care Service Line, a Specialty Pharmacy, an optional Mail Order Pharmacy, and an updated Formulary. You will also have access to an extended network of conveniently located pharmacies in and out of Santa Clara County.
Here is a list of your new pharmacy locations and services:
- 24/7 pharmacies at several locations
- Drive-thru pharmacies at several locations
Prescription refill options
- Online refills
- Auto refills
- iPhone® & Android™ refill apps
- Prescription transfer online or in store
- Option to pick up in store or mail
- Chat 24/7 with pharmacy staff
View and print your prescription records
Palo Alto Medical Foundation (PAMF) Pharmacies
- Mountain View Center
- Palo Alto Center
Santa Clara Valley Medical Center (SCVMC) Pharmacies
- Valley Health Center Bascom
- Valley Health Center East Valley
- Valley Health Center Gilroy
- Valley Health Center Milpitas
- Valley Health Center Moorpark
- Valley Health Center Sunnyvale
- Valley Health Center Tully
- Valley Specialty Center
Option to pick up or mail
The SCVMC Pharmacies are for VHP Members receiving care from providers at Santa Clara Valley Medical Center, Valley Specialty Center, and Valley Health Centers ONLY.
VHP will be sending you more details on how to access the new pharmacy network. Check your mailbox for additional information to come!
Issue 1 | January 2011
In this Issue:
• Revised Evidence of Coverage & Disclosure Form Booklet Coming Soon
• Health Care Reform - Dependent Coverage Changes
• VHP Network Expansion
• Timely Access GuidelinesRevised Evidence of Coverage & Disclosure Form Booklet Coming Soon
Valley Health Plan (VHP) recently revised its Evidence of Coverage & Disclosure Form (EOC) booklet to reflect new regulations and benefit information. The EOC is your contract with the health plan that lists your benefits and how to access care. VHP was required to submit the EOC for approval with the State’s Department of Managed Health Care (DMHC). The EOC was approved so we are in the process of printing the booklet and once that is completed it will be mailed directly to you. This booklet will also be posted on our website www.valleyhealthplan.org for online viewing.
Just as a reminder to members, VHP information mailed to you regarding benefits changes, additions or changes in practice/policy acts as an update to the most current Evidence of Coverage & Disclosure Form booklet. You may want to keep these mailings for future reference however, our Member Services staff is able to help you at any time in person or over the phone when you have questions or concerns. Health Care Reform - Dependent Coverage Changes
How does Health Care Reform change my dependent’s eligibility for coverage?
One of the many provisions of Health Care Reform (officially known as the Patient Protection and Affordable Care Act of 2010) is it will extend health insurance coverage to dependents up to age 26. This coverage is regardless of whether the dependent is a full-time student, their tax dependent status, whether they are married or unmarried, and whether or not they reside with the parent. One temporary exception to this new law (until the 2014 plan year), excludes coverage if the dependent 18 years or older is eligible to enroll in an employer sponsored plan other than his/her parent’s plan. When can I add my Dependents?
This new law becomes effective based on your Employer’s contract year with their health plan providers. To find out when this new law is effective with your Employer group, please contact your Human Resources/Personnel Department for details on how and when you can add your dependents up to age 26. VHP Network Expansion
Several years ago, Valley Health Plan added approximately 350 new Primary Care Physicians (PCPs) to its network. We continue to work on growing and expanding your choices for Primary Care. We are currently in the process of signing contracts with some well known local provider groups. We will notify you by mail about this exciting announcement. Once these new provider group contracts are effective and if you are interested, you can change your PCP by calling our Member Services Department.