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How to Access St. Joseph Health Under Covered California

In Southern California, St. Joseph Health's affiliated and medical group physicians (see list below) and our hospitals are participating in Covered California through the Blue Shield of California PPO and in Northern California, participation is through the Blue Shield of California EPO and the Western Health Advantage HMO. You may also select the Health Net PPO option, but be sure to check with your physician that he/she is contracted with this plan. You must choose these plans to access our affiliated and medical group doctors, as well as our hospitals. Our affiliated and medical group physicians and hospitals do not accept any other health plans under Covered California.

Here are some frequently asked questions and answers:

1. Who are the St. Joseph Health affiliated and medical group physicians?

In California, the affiliated and medical group physicians of St. Joseph Health are part of:

SOUTHERN CALIFORNIA (ORANGE COUNTY)

  • Mission Heritage Medical Group
  • Mission Hospital Affiliated Physicians
  • Mission Internal Medical Group
  • St. Joseph Heritage Medical Group
  • St. Joseph Hospital Affiliated Physicians
  • St. Jude Heritage Medical Group
  • St. Jude Affiliated Physicians

SOUTHERN CALIFORNIA (HIGH DESERT)

  • Premier Healthcare
  • St. Mary High Desert Medical Group (formerly High Desert Primary Care and St. Mary Specialty Clinic)

NORTHERN CALIFORNIA

  • Annadel Medical Group
  • Humboldt Medical Specialists
  • Queen of the Valley Medical Associates

2. I heard that Covered California removed the online provider directory from their website due to errors in the information. Can I change plans if I made a mistake when I enrolled?

Yes, you can switch your health plan carrier during open enrollment (before March 31, 2014).

3. What type of plans are offered?

Four main types are offered — bronze, silver, gold and platinum — with bronze providing the least amount of coverage and platinum the most. As you move from bronze to platinum, premiums rise, but your coverage improves and out-of-pocket costs go down.

4. Who qualifies for a subsidy to help pay for premiums?

Those who earn between 138 percent and 400 percent of the federal poverty level qualify. This year, that would be up to $44,680 for an individual and $92,200 for a family of four. Subsidies vary based on income and family size, and are in the form of tax credits that will be advanced, meaning that each month you will only have to pay that part of the premium that is not subsidized.

5. Does the exchange take the place of Medi-Cal?

No, Medi-Cal is a different plan and is generally less expensive than the exchange for an individual or family. However, you must be eligible for Medi-Cal. To see if you are eligible for Medi-Cal, go to www.benefitscal.org.

6. How much do people pay if they don't have health insurance?

Most citizens and legal residents are required to have coverage or pay a penalty. Some people may be exempt, including those who are uninsured for less than three months or who would have to pay more than 8 percent of their household income for premiums.

7. What are the essential benefits health plans must provide in 2014

Physician and other ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

8. In Southern California, is Hoag part of the network?

Yes, Hoag physicians can be accessed through the "Hoag Affiliated Physicians" medical group.

9. How can I find out more information?

To sign up for Covered California, go to www.coveredca.com. To find a St. Joseph Health affiliated or medical group physician, go to www.chooseyourdoc.org. (Note: St. Joseph Health affiliated and medical group names are listed under Question One, above.)