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    Participating Health Plans

    Last Updated: August 25, 2015

    The health plans marked with an asterisk (*) below are in negotiations for renewal in 2016.

    Click here for Medicare Plans

    Please note, if you are an HMO/POS health plan member and pick a primary care physician in the Mills-Peninsula Division of PAMF, your specialty care, laboratory and radiology services will be provided by physicians in the Mills-Peninsula network. This network includes specialist physicians in Daly City, San Bruno, Millbrae, Burlingame, Foster City, and San Mateo.

    Individual and Family Plans


    Individual and Family Plans (IFP) may be purchased outside the state’s health benefit exchange (Covered California) through the health plan or an insurance broker. For more information, please contact the health plan or insurance broker of your choice directly. If you qualify for a federal tax credit or subsidy, you must enroll for coverage through Covered California to receive this financial assistance.

    Assurant Health PPO (Aetna Signature Administrators network)
    Assurant Health PPO (First Health network)
    Blue Shield Platinum 90 EPO/PPO
    Blue Shield Gold 80 EPO/PPO
    Blue Shield Silver 70 EPO/PPO
    Blue Shield Silver 73 EPO/PPO
    Blue Shield Silver 87 EPO/PPO
    Blue Shield Silver 94 EPO/PPO
    Blue Shield Bronze 60 EPO/PPO
    Blue Shield Bronze 60 HSA EPO/PPO
    Blue Shield Minimum Coverage EPO/PPO
    Blue Shield $0 Cost Share EPO/PPO
    Health Net Individual & Family Plan (IFP) PPO Bronze
    Health Net Individual & Family Plan (IFP) PPO Catastrophic
    Health Net Individual & Family Plan (IFP) PPO Gold
    Health Net Individual & Family Plan (IFP) PPO Platinum
    Health Net Individual & Family Plan (IFP) PPO Silver

    Covered California


    Covered California is this state's Health Benefit Exchange. If you buy coverage through Covered California, you may qualify for federal tax credits or subsidies. (You may also purchase individual and family plans outside Covered California.) For more information regarding plans offered in your zip code, please visit www.CoveredCA.com, or call 800-300-1506.

    Covered California's 2016 open enrollment period is November 1, 2015 through January 31, 2016.

    Health Net PPO for Small Business Health Options Program (SHOP)
    Blue Shield Platinum 90 EPO/PPO
    Blue Shield Gold 80 EPO/PPO
    Blue Shield Silver 70 EPO/PPO
    Blue Shield Silver 73 EPO/PPO
    Blue Shield Silver 87 EPO/PPO
    Blue Shield Silver 94 EPO/PPO
    Blue Shield Bronze 60 EPO/PPO
    Blue Shield Bronze 60 HSA EPO/PPO
    Blue Shield Minimum Coverage EPO/PPO
    Blue Shield $0 Cost Share EPO/PPO
    Blue Shield PPO (SHOP)

    Insurance Plans

    Aetna
    Aetna Affordable Health Choices (Indemnity)*
    Aetna Choice POS*
    Aetna Choice II POS*
    Aetna Open Access Elect Choice (EPO)*
    Aetna Open Access Managed Choice (POS/PPO)*
    Aetna Savings Plus PPO* (only at San Mateo/Burlingame area locations)
    Aetna Select EPO*
    Aetna Signature Administrators (PPO)*
    Aetna Student Health Program*
    Aetna Value Network (AVN)* (only at San Mateo/Burlingame area locations)
    Aexcel & Aexcel Plus*
    Choose and Save*
    Behavioral Health Program*
    Elect Choice EPO*
    HMO*
    HMO Deductible Plans*
    Health Fund HMO*
    Health Fund PPO*
    Managed Choice POS (POS/PPO)*
    National Advantage Plan (NAP)*
    Open Access Select (EPO)*
    Open Choice PPO*
    Quality Point of Service (QPOS)*
    Traditional Choice*
    US Access (HMO/POS)*

    Anthem Blue Cross
    PAMF is NOT participating in Anthem Blue Cross Covered California insurance plans. If your insurance card indicates "Pathway" or Pathway X" as the network, PAMF does not participate in your plan.

    Advantage PPO*
    Anthem Blue Cross HMO Saver Small Group Plan* (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Anthem Blue Cross HMO (California Care)*
    Anthem Blue Cross HMO/POS (California Care Plus)*
    Anthem Blue Cross HMO Saver Small Group Plan* (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Anthem Blue Cross Individual HMO* (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Anthem Blue Cross Small Group HMO* (only at Mountain View/Sunnyvale, San Jose/Los Gatos area locations)
    Behavioral Health Program*
    BlueCard (Blue Cross Blue Shield PPO)*
    Blue Cross PPO (Prudent Buyer Plan Network)*
    CalPERS Traditional HMO*
    Direct Access HMO (Traditional HMO Network)*
    Federal Employee Program (FEP) EPO*
    Federal Employee Program (FEP) PPO*
    Geo Blue*
    Indemnity*
    Managed Care Services (MCS)*
    My Choice PPO*
    PERS Care*
    PERS Choice*
    Power Advantage HMO*
    Power Care Advocate PPO*
    Power Health Fund PPO*
    Smart Sense Plus*

    Blue Shield
    Sutter Health, on behalf of Palo Alto Medical Foundation, and Blue Shield of California reached agreement on a new two-year contract with Blue Shield of California, preserving patient access to our doctors and hospitals. It applies to all Blue Shield products in which Palo Alto Medical Foundation providers historically participated, including HMO, PPO and those offered through Covered California. There will be no lapse in coverage for our Blue Shield patients.

    BlueCard (Blue Cross Blue Shield PPO)
    Blue Shield Access+ CCSF Plan
    Blue Shield Access+ HMO Plan
    Blue Shield Access+ HMO for Individuals and Families
    Blue Shield Access+ HMO/EPO CalPERS Limited Network
    Blue Shield Added Advantage Point of Service (POS)
    Blue Shield Bronze 60 EPO/PPO
    Blue Shield Bronze 60 HSA EPO/PPO
    Blue Shield Gold 80 EPO/PPO
    Blue Shield Life & Health Insurance Company
    Blue Shield Minimum Coverage EPO/PPO
    Blue Shield Platinum 90 EPO/PPO
    Blue Shield PPO (SHOP)
    Blue Shield Silver 70 EPO/PPO
    Blue Shield Silver 73 EPO/PPO
    Blue Shield Silver 87 EPO/PPO
    Blue Shield Silver 94 EPO/PPO
    Blue Shield Spectrum PPO Plan
    Blue Shield Spectrum PPO Savings Plan
    Blue Shield $0 Cost Share EPO/PPO
    Federal Employee Program (FEP) EPO
    Federal Employee Program (FEP) PPO
    Indemnity
    Shared Advantage & Shared Advantage Plus PPO - ASO
    Stanford University EPO - ASO
    UC Care (PPO) Tier 1
    Vital Shield 900 and Vital Shield 2900 Plans

    Cigna
    Cigna Care Network
    Commercial HMO/POS
    EPO Plan
    Global Health Advantage (PPO)
    Great-West Open Access
    Great-West Point of Service (POS)
    Great-West Preferred Provider Organization (PPO)
    Indemnity Plan
    International Plan
    Network HMO/POS
    Open Access Plus (PPO)
    Preferred Provider Organization (PPO)

    First Health/Coventry Health Care
    PPO

    Health Net
    Blue & Gold HMO (only at San Mateo/Burlingame area locations)
    Elect Open Access POS, for Large Group and Small Group
    Elect POS, for Large Group and Small Group
    EPO (El Camino Hospital Employees)
    HMO, Flex Funded
    HMO, for Large Group and Small Group
    Healthy Heart HMO*
    Managed Health Network (MHN)
    PPO, for Individuals, Large Group, and Small Group
    Health Net PPO for Small Business Health Options Program (SHOP)
    PPO IFP Bronze
    PPO IFP Catastrophic
    PPO IFP Gold
    PPO IFP Platinum
    PPO IFP Silver
    Salud HMO Plus Large/Custom Group
    Select POS (two and three tier), for Large Group and Small Group
    Seniority Plus (Medicare Advantage HMO) (Employer-Sponsored)* - Medicare Advantage Plan Info
    Seniority Plus Complete*
    Seniority Plus Green*
    Seniority Plus Ruby*
    Vaden EPO

    Health Smart (formerly Interplan)
    Choice Care Network
    PPO

    Humana Medicare Advantage
    Humana Gold Plus (HMO) (only at Santa Cruz area locations)

    Multiplan
    Primary Network PPO

    Pacific Health Alliance
    PPO

    Pre-Existing Condition Insurance Plan
    Pre-Existing Condition Insurance Plan (PCIP)

    Sutter Select
    EPO
    PPO

    TriCare
    Extended Care Option (ECHO)
    Extra
    Prime
    Prime Remote
    Reserve Select
    Standard

    United Healthcare
    AARP MedicareComplete SecureHorizons (HMO)* Medicare Advantage Plan Info
    Definity Health
    Health Plan of Nevada (HMO)
    Sierra Health and Life (PPO)
    Signature Freedom (SDHP)
    Signature Independence (Indemnity)
    Signature Options (PPO)
    Signature POS
    Signature Value (HMO)
    Signature Value Access (EPO)
    Signature Value Alliance HMO (includes CalPERS & AON Exchange)
    United Healthcare Choice (Non-Tiered)
    United Healthcare Choice Plus (Non-Tiered)
    United Healthcare EPO
    United Healthcare Options PPO
    United Healthcare POS
    United Healthcare Select and Select Plus (PPO)
    United Indemnity Plan
    United Managed Indemnity Plan
    United Healthcare Group Medicare Advantage (HMO)* Medicare Advantage Plan Info
    United Healthcare Group Medicare Advantage (PPO)* Medicare Advantage Plan Info
    United Healthcare MedicareComplete (HMO)* Medicare Advantage Plan Info
    US Behavioral Health Plan, California (USBHPC)

    Valley Health Plan
    Commercial HMO

    Viant/Beech Street
    PPO

    Psychiatry & Behavioral Health Plans


    Aetna Behavioral Health Program*
    Anthem Blue Cross Behavioral Health Program*
    Health Net Managed Health Network (MHN)
    US Behavioral Health Plan, California (USBHPC)

    Coverage for psychiatric and behavioral health services varies by health plan. Some plans have a "carve-out" for mental health care, meaning services are covered by a separate organization that the patient must contact directly.

    Medicare Advantage Plans


    Health Net Medicare Advantage Products

    • Healthy Heart HMO*
    • Seniority Plus Complete*
    • Seniority Plus Green*
    • Seniority Plus Ruby*
    • Seniority Plus (employer-sponsored)*
    Please check with your health plan if you have any questions about coverage or specific products offered. Plan contact information: Health Net Seniority Plus (a Medicare Advantage Plan) 1-800-418-6565 (TDD/TTY 1-800-929-9955), 8 a.m. to 8 p.m., 7 days a week. www.healthnet.com

    Humana
    • Humana Gold Plus (HMO)
    For assignment, you must select a primary care physician at one of Santa Cruz County locations. Please check with your health plan if you have any questions about coverage or specific products offered. Plan contact information: Humana (a Medicare Advantage Plan) 1-866-945-4481. www.humana.com/medicare/

    United Healthcare Medicare Advantage Products

    • AARP MedicareComplete SecureHorizons (HMO)*
    • United Healthcare Group Medicare Advantage (HMO)*
    • United Healthcare Group Medicare Advantage (PPO)*
    • United Healthcare MedicareComplete (HMO)*
    Please check with your health plan if you have any questions about benefits, specific products, or provider network. Plan contact information: United Healthcare of California, 1-800-607-2877 (TDD/TTY: 711), 8 a.m. to 8 p.m., 7 days a week. www.UHCMedicareSolutions.com

    PAMF also participates in Medicare A & B and Medicare Supplement ("Medi-Gap") insurance plans. If you are a Medicare Advantage patient and revert to traditional Medicare, you may keep your current provider(s). The open enrollment period for Medicare Advantage plans is October 15 to December 7. For more information, visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).

    Additional Information


    We make every effort to keep this list as accurate as we can for our current participating health plans. Plan names may change at the discretion of the insurance company. We have listed our participating plans based on the product names provided by the insurance companies. Even so, it is possible that not every health plan and circumstance is addressed here. Please check with your health plan if you have any questions about benefits, specific products, or provider network.

    You can obtain the most accurate and timely information by calling your insurance company or employer's benefits department and confirming your coverage level when choosing a PAMF physician.

    Special note for POS, PPO, and Indemnity plans not listed:
    You always have a choice of seeing a physician who is not listed in the PPO or POS directory. A copay and/or deductible may apply. Consult your benefits summary or evidence of coverage for details.

    If you have questions about participating health plans, call our toll free number -- 1-877-252-1777.


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