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    Health Plans We Accept

    Last Updated: November 21, 2014

    If you have HMO insurance, please read this first... (opens to new window)

    Click here for Medicare Plans

    Please note, if you pick a physician who is a member of 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, San Mateo and San Carlos.

    Covered California

    2015 Open Enrollment is November 15, 2014 to February 15, 2015.

    Please note that Sutter Health, on behalf of Palo Alto Medical Foundation, is currently in negotiations with Blue Shield and Health Net to renew our contracts for 2015. We hope to successfully complete these renewals by the end of 2014 to avoid any disruption in physician participation; however, it is important to note that not all of the Sutter Health network of providers participate in all of the Health Plan's products or networks. Please check with your health plan directly if you have questions about benefits and or a specific product or provider network.

    Blue Shield Basic PPO/EPO Plans (Bronze)
    Blue Shield Enhanced Full HMO for SHOP (Silver)
    Blue Shield Enhanced PPO/EPO Plans (Silver)
    Blue Shield Get Covered PPO/EPO Plans (Catastrophic)
    Blue Shield PPO (SHOP)
    Blue Shield Preferred Full HMO for SHOP (Gold)
    Blue Shield Preferred PPO/EPO Plans (Gold)
    Blue Shield Ultimate Full HMO for SHOP (Platinum)
    Blue Shield Ultimate PPO/EPO Plans (Platinum)
    Health Net PPO Bronze
    Health Net PPO Catastrophic
    Health Net PPO Gold
    Health Net PPO Platinum
    Health Net PPO SHOP
    Health Net PPO Silver

    Covered California is this state's Health Benefit Exchange. For more information on 2014 and 2015 plans offered in your ZIP code, please visit www.CoveredCA.com, or call 800-300-1506.

    PAMF participates in Blue Shield's Covered California Individual & Family Plans (IFP) and Small Business Health Options Program (SHOP) Plans. For IFP, we understand that Blue Shield has excluded some ZIP codes within Alameda and Santa Cruz counties from participating in the Covered California products. For more information, please contact Blue Shield, or call (888) 568-3560.

    PAMF also participates in Health Net's Covered California Individual & Family Plans (IFP) and Small Business Health Options Program (SHOP) Plans. For more information, please contact Health Net, or call (877) 527-8409.

    Attention Health Net Covered California members: Palo Alto Medical Foundation physicians will not be participating in the Health Net Covered California PureCare individual and family plan network in 2015.

    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.

    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

    Please note that Sutter Health, on behalf of Palo Alto Medical Foundation, is currently in negotiations with Blue Shield to renew our contract for 2015. We hope to successfully complete these renewals by the end of 2014 to avoid any disruption in physician participation; however, it is important to note that not all of the Sutter Health network of providers participate in all of the Health Plan's products or networks. Please check with your health plan directly if you have questions about benefits and or a specific product or provider network.

    Basic PPO/EPO Plans (Bronze)
    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 Life & Health Insurance Company
    Blue Shield PPO (SHOP)
    Blue Shield Spectrum PPO Plan
    Blue Shield Spectrum PPO Savings Plan
    Enhanced Full HMO for SHOP (Silver)
    Enhanced PPO/EPO Plans (Silver)
    Federal Employee Program PPO
    Get Covered PPO/EPO Plans (Catastrophic)
    Indemnity
    Preferred Full HMO for SHOP (Gold)
    Preferred PPO/EPO Plans (Gold)
    Shared Advantage & Shared Advantage Plus PPO - ASO
    Stanford University EPO - ASO
    UC Care (PPO) Tier 1
    Ultimate Full HMO for SHOP (Platinum)
    Ultimate PPO/EPO Plans (Platinum)
    Vital Shield 900 and Vital Shield 2900 Plans

    Cigna
    Cigna Care Program (CCP)
    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)

    Coastal Healthcare Administrators
    PPO

    First Health/Coventry Health Care
    PPO

    Health Net

    Please note that Sutter Health, on behalf of Palo Alto Medical Foundation, is currently in negotiations with Health Net to renew our contract for 2015. We hope to successfully complete these renewals by the end of 2014 to avoid any disruption in physician participation; however, it is important to note that not all of the Sutter Health network of providers participate in all of the Health Plan's products or networks. Please check with your health plan directly if you have questions about benefits and or a specific product or provider network.

    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
    PPO Bronze
    PPO Catastrophic
    PPO Gold
    PPO Platinum
    PPO SHOP
    PPO 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 Green
    Seniority Plus Ruby
    Vaden EPO

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

    Interplan Health Group (Health Smart)
    Choice Care Network
    PPO

    Multiplan
    Primary Network PPO

    Pacific Health Alliance
    PPO

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

    Satellite Health Plan
    Satellite Health Plan (HMO SNP)

    Sutter Select
    EPO
    PPO

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

    United Healthcare

    Please note that Sutter Health, on behalf of Palo Alto Medical Foundation, is currently in negotiations with United Healthcare to renew our contract for HMO/POS and PPO products for 2015. We hope to successfully complete these renewals by the end of 2014 to avoid any disruption in physician participation; however, it is important to note that not all of the Sutter Health network of providers participate in all of the Health Plan's products or networks. Please check with your health plan directly if you have questions about benefits and or a specific product or provider network. Medicare Advantage is renewed for 2015.

    AARP MedicareComplete SecureHorizons (HMO) (Renewed for 2015) - 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
    United Healthcare Choice
    United Healthcare Choice Plus
    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) (Renewed for 2015) - Medicare Advantage Plan Info
    United Healthcare MedicareComplete (HMO) (Renewed for 2015) - Medicare Advantage Plan Info

    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)

    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


    PAMF currently participates in the following Medicare Advantage plans:

    Health Net Medicare Advantage Products

    Please note that Sutter Health, on behalf of Palo Alto Medical Foundation, is currently in negotiations with Health Net to renew our contract for 2015. We hope to successfully complete these renewals by the end of 2014 to avoid any disruption in physician participation; however, it is important to note that not all of the Sutter Health network of providers participate in all of the Health Plan's products or networks. Please check with your health plan directly if you have questions about benefits and or a specific product or provider network.

    • Healthy Heart HMO
    • 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/

    Satellite Health Plan
    • Satellite Health Plan (HMO SNP)
    Please check with your health plan if you have any questions about coverage or specific products offered. Plan contact information: Satellite Health Plan (a Medicare Advantage Plan) 1-888-978-6095. www.satellitehealthplan.com

    United Healthcare Medicare Advantage Products

    Medicare Advantage is renewed for 2015.

    • AARP MedicareComplete SecureHorizons (HMO)
    • United Healthcare Group Medicare Advantage (HMO)
    • 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 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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