FAQ Members

What is Community Care Health Plan’s service area?
Community Care Health Plan is Fresno’s only locally based, commercial health plan. We serve members based in Fresno and adjoining counties. See a list of all ZIP CODES included in Community Care Health Plan’s service area.
 
Can Community Care Health Plan members get covered care outside of the Plan’s service area?
Yes, as a Community Care Health Plan member you’re covered for emergency care wherever you are, although routine care is only covered at home in our service area. If you think you’re having a medical or psychiatric emergency call 911 or go to the nearest hospital.
 
Will I be able to choose my own specialists or will my primary care physician make that decision for me? 
You and your primary care physician (PCP) will determine the best specialist for your particular needs. In some cases you may be able to see a specialist directly without a referral from your PCP. No referral is required for pediatricians, and women can see participating obstetricians and gynecologists without a referral.
 
If you have any questions about how to see a specialist call customer service at (855) 343-2247.
 
Which services are covered under Community Care Health Plan?
Community Care Health Plan is a comprehensive health care service plan that offers a full range of medical care.  Covered services always include coverage for doctor office visits, hospital stays, surgery, outpatient procedures, preventive services (periodic immunizations, physical exams, and routine screenings) and much more. These services are provided at varying levels of copayments and/or coinsurance. Coverage varies depending on the benefit plan you’re enrolled in. Contact member services if you have questions about which services are covered under your plan and your cost share.
 
Where can I get a summary of my benefits?
You can obtain a Summary of Benefits from your human resources department or you can contact us to have a benefits summary sent to you.
 
What if I have an emergency situation?
Call 911 or go to the closest emergency room anytime you have a life-threatening emergency. If you’re not sure it’s an emergency call your doctor’s office for advice.
 
It’s an emergency if your symptoms are so severe that you believe not getting medical care right away could place your health or someone else’s (or the health of an unborn child) at risk OR cause major harm to a body part or function. If you feel you’re having an emergency you don’t need an OK from us or your primary care physician to get care.
 
What mental health services are covered?
As a Community Care Health Plan Member you have access to great resources like:
  • Mental health care services for all ages
  • Inpatient hospital services
  • Outpatient services
  • Access to Community Care Health Plan providers without primary care physician referral
For more information about your benefits call our customer care team toll-free at (855) 343-2247.
 
How do I get mental health services? 
You don’t need a referral from your primary care physician to get access to mental health services. However, only services offered through plan providers will be covered. So the best way to ensure coverage is to find a doctor in your network before taking the next step.
 
Find a provider at www.communitycarehealth.org/providersearch
 
If my spouse loses health coverage through his or her employer can he or she be covered under my Community Care Health Plan?
In most cases, yes. If you’re a Community Care Health Plan member when your spouse loses group coverage through his/her employer, your spouse may enroll as a dependent under Community Care Health Plan, so long as enrollment occurs within 31 days of the date coverage ended under the former health plan.

Can I add or remove my spouse or partner to my Community Care Health Plan coverage if open enrollment is over?
Yes, as long as there has been a qualified family change, such as marriage. Enrollment must occur within 31 days of the time your dependents first become eligible to join (that is, within 31 days of marriage or domestic partnership.)