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Fall Into Preventive Care!
COVID-19 & Flu Vaccine Information Read more on pg.4 inside!
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VHP CHIEF EXECUTIVE OFFICER Laura E. Rosas, JD, MPH VHP CHIEF MEDICAL OFFICER Ghislaine Guez, MD VHP CHIEF OPERATIONS OFFICER Debra Halladay
A Message From: Laura Rosas VHP Chief Executive Officer (CEO) Welcome to VHP’s (Valley Health Plan) Fall “Member Update” newsletter. As the days grow shorter, cooler (and hopefully wetter), our thoughts begin to focus on the upcoming holiday season. As we move forward, we want to encourage COVID-19 vaccination for those of you who may still be undecided. It is also that time of year for flu shots. The flu season this year is likely to be more serious due to the reopening of our economy. In addition, a person can contract both flu and COVID-19 at the same time, potentially a devastating condition. Please consider vaccination to protect yourself, your family, friends, and your community. For many of you, due to the pandemic, this may be the first time you have celebrated holidays with distant family and friends. For others, you may have lost loved ones to this pandemic. Our hearts and thoughts are with you all as you navigate the future. We want you to know that VHP is here for you. Please reach out to Member Services at 1.888.421.8444 with any questions or concerns about Providers, services, or benefits. Thank you again for putting your trust in VHP. We wish you the best of the Autumn season and the holiday season to come. Best, Laura Rosas, VHP CEO
Language Assistance Available to You! Valley Health Plan (VHP) wants to let our Members know we speak their language! VHP continues to provide high quality language services with over 150 languages available including American Sign Language. There is no need to ask your family or friends to assist with translation. Services are FREE to all VHP Members. To access language assistance or learn more about this service please contact Member Services at 1.888.421.8444 (toll-free) or by email at MemberServices@vhp.sccgov.org.
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VHP CHIEF FINANCIAL OFFICER Paul Antigua VHP CHIEF BUSINESS DEVELOPMENT OFFICER David Hurst VHP ASSISTANT DIRECTOR, PROVIDER NETWORK OPERATIONS Justin Keller VHP ASSISTANT DIRECTOR, BEHAVIORAL HEALTH SERVICES Chris Jaquis VHP MEDICAL DIRECTOR Elizabeth Murphy, MD VHP MEDICAL ADVISORS Stephen Harris, MD COUNTY OF SANTA CLARA BOARD OF SUPERVISORS Mike Wasserman, District 1 Cindy Chavez, District 2 Otto Lee, District 3 Susan Ellenberg, District 4 Joe Simitian, District 5 COUNTY EXECUTIVE Jeffrey V. Smith, MD, JD
Member Update Since July of 2020, we have been able to add various new primary care and specialty Providers, expand our programs for behavioral health service, grow access to services in the counties adjacent to Santa Clara county, and gain approval to expand coverage for Covered California and Individual and Family Plans in the entirety of San Benito and Monterey counties*. Although these have been challenging times, VHP is excited to bring you these expanded services and continues to work hard to expand networks to meet your health care needs.
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COVID-19 Fall Information
THIS FALL, GIVE YOUR IMMUNITY A BOOST! pg.5
Give your Immunity a Boost!
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Open Enrollment
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Senate Bill 855 Information
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More Important News!
* Open enrollment for Covered California and Individual & Family Plans in San Benito and Monterey Counties will start on 11/01/2021 for health coverage in the calendar year 2022.
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www.valleyhealthplan.org / 3
Fall COVID-19 Information Herd immunity is essential in the fight against COVID-19, the more of us that are vaccinated, the closer we are to stopping COVID-19 and protecting our loved ones and communities.
COVID-19 Vaccines are safe: • Millions of people ages 12 + in the U.S. have gotten their COVID-19 vaccines under the most intense safety monitoring in U.S. history. No long-term side effects have been detected. • The FDA and CDC continue to closely monitor the safety of COVID-19 vaccines. • Vaccine side effects can affect your daily activities but should go away in a matter of days.
How to protect children who are not old enough to get vaccinated (11 and under): For those of us with younger children who are unable to get vaccinated (11 and under), adults and older siblings can help decrease the risk to these younger children by avoiding public, or crowded, indoor settings. When these situations cannot be avoided, the CDC suggests everyone wear a mask indoors, regardless of vaccination status. The CDC also suggests everyone who is 12 and over get vaccinated to protect those who are not.
How to safely gather this Fall: • Social gatherings should remain outdoors when possible. Dress in layers, gather around a fire pit or heat lamp. • A brisk, socially distanced, walk can help keep you social, warm, and healthy as the cool months approach. • If outdoors, and maintaining a social distance of at least 6 feet, you do not need to wear your mask. • If you are outdoors in a crowded area, or on streets where avoiding strangers is difficult, please wear your mask. • Consider a new way to celebrate the holiday season, informal gatherings with friends and family are where we tend to let our guard down and where the virus is quick to spread. Covid doesn’t take a holiday break, and neither should we.
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Give Your Immunity a Boost! Get an Immunity Update This Fall With Your Seasonal Flu Shot! Why is getting the flu vaccine important? The flu shot prevents hospitalizations, especially in young children, pregnant women, people over 65, and high-risk populations. Though you can still get the flu, even after being vaccinated, studies show the flu vaccine reduces deaths and ICU admits, as well as, the length of stay. In other words, getting your flu shot will reduce the severity of your symptoms and could help save lives. Getting vaccinated will also help protect the people around you.
Practice Healthy Habits How does the flu spread? The flu spreads through tiny droplets made by a person from coughing, sneezing, or even talking. These droplets can land in the noses or mouths of surrounding people. The flu can also spread by touching something that has the flu virus on it (such as doorknobs, railings, and shared surfaces) and then touching your face (nose, eyes, mouth).
Common Symptoms
• Wear a mask that covers your nose and mouth whenever going out in public.
• Shortness of Breath
• Wash your hands often and for at least 20 seconds.
• Fever
• When soap and water are not available, use an alcohol-based hand sanitizer. • If you are sick or have any of the symptoms listed “below” (cough, fever, etc.), please stay home. • Everyone 6 months and older should get their flu vaccine.
• Cough
• Fatigue
Where can I get my vaccine? Contact your Personal Care Provider (PCP) or your VHP covered Pharmacy to schedule your Flu Shot!
*If you have symptoms and are in a high-risk group (young children, adults 65 and older, pregnant women, and/or diagnosed with certain medical conditions), are very sick (examples? List? High-grade fever?), or concerned about your illness, please contact your PCP for advice. 5 / Perspectives Fall 2021 Newsletter 5 / Perspectives Fall 2021 Newsletter
This year, Open Enrollment will start on November 1, 2021, and continue through January 31, 2022. Open Enrollment is the only time of year when current Members can make changes to their metal tier without a Qualifying Life Event, such as getting married, having a baby, moving to a new service area, or losing coverage. Got a high deductible? VHP Members who are currently enrolled in a Catastrophic or Bronze Plan may want to consider upgrading to a Silver Plan for a lower deductible and lower co-pays. A Silver Plan is an excellent option for VHP Members who use their coverage more often. If you wish to keep your current VHP plan, you will be automatically renewed into the same plan for 2022. If you want to make changes to your metal tier, you must do so during the Open Enrollment Period. Don’t wait! Upgrade your metal tier before December 15, 2021, to start your new VHP Plan by January 1, 2022. Our team is here to help you review your subsidy eligibility, enroll in VHP, and save with the lowest cost plans for the most popular metal tiers. Coverage can start as soon as the 1st of the month following plan selection. For enrollment assistance contact your VHP Broker or the VHP Sales Team by calling 408.885.3560 or email us at BrokerRelations@vhp.sccgov.org to get started.
Valley Health Plan (VHP) Sales Team! Ashley Bejarano VHP Sales Manager 669.242.4252 Ashley.Bejarano@vhp.sccgov.org
Betty Ho VHP Sales 408.970.2240 Betty.Ho@vhp.sccgov.org
Joey Gonsalvez VHP Sales 408.885.3674 Joey.M.Gonsalves@vhp.sccgov.org
Revecca Lopez VHP Sales 408.316.3172 Revecca.Lopez@vhp.sccgov.org
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Mental Health as a Medical Necessity VHP will cover your mental health and substance abuse treatment under the following circumstances: • The treatment is considered “medically necessary” • The treatment is covered by your benefit plan • The treatment is administered from a contracted healthcare provider. What does “medical necessity” mean for mental health and substance abuse treatment? “Medically necessary” treatment of a mental health or substance use disorder means a service or product addressing the specific needs of that member, for the purpose of preventing, diagnosing, or treating an illness, injury, condition, or its symptoms, including minimizing the progression of that illness, injury, condition, or its symptoms, in a manner that is all of the following: • Meets the generally accepted standards of mental health and substance use disorder care. • Clinically appropriate in terms of type, frequency, extent, site, and duration • Not primarily for the economic benefit of the health care service plan and members or for the convenience of the patient, treating physician, or other health care provider. VHP determines the medical necessity of health care services for mental health and substance use disorders based on the guidelines of professional clinical associations. • Early Childhood Service Intensity Instrument (ECSII) for children under age 5 • CALOCUS = Child/Adolescent Level of Care Utilization System • LOCUS = Level of Care Utilization System for Adults VHP utilizes clinical guidelines from The American Society of Addiction Medicine (ASAM) to determine medical necessity for substance use disorders, and World Professional Association for Transgender Health (WPATH) guidelines to determine medical necessity for care related to gender dysphoria. If you would like to learn more about these guidelines, contact VHP Member Services at 1.888.421.8444, email memberservices@vhp.sccgov.org, or see our website www.valleyhealthplan.org/members/ behavioral-health.
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More Important News and Information At VHP we know that life is hectic and keeping up on how to get the most out of your health plan is often the furthest thing from your mind. So, we’ve made it easy. Visit www.valleyhealthplan.org > Member Materials > Forms & Resources for information about the following important subjects.
• Advance Health Care Directive
• Grievance and Appeals Process
• Affirmative Statement About Financial Incentives
• Language Assistance
• Autism Care Management Program
• Lock-In Provision
• Change of Address
• Member Rights and Responsibilities
• Choosing and Changing Your Primary Care Practitioner (PCP)
• Non-Discrimination
• Chronic Condition Management Program
• Provider Directory
• Combined Evidence of Coverage • Coordination of Benefits • Emergency and Urgent Care Services
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• Protected Health Information • Self-Refer Services (Direct Access) • Timely Access • Waste, Fraud and Abuse