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CA HCO Online Enrollment Portal Please enter the member's date of birth Then enter the Social Security number (SSN) or client identification number (CIN)
How to Fill Out the Medi-Cal Choice Form - California How to Fill Out the Medi-Cal Choice Form Use the MEDI-CAL CHOICE FORM(S) in this packet to join a health plan or to choose Regular Medi-Cal (Fee-For-Service) Benefits will not change for voluntary beneficiaries who remain in Regular Medi-Cal (Fee-For-Service) Fill out one form for each family member You can get more forms by calling Health Care Options at 1-800-430-4263
Member - California [member services telephone number] (TTY [member services TTY number] or 711) The call is free [MCP should edit “member services” as appropriate throughout this Member Handbook to match the name MCP uses MCP may also add contact information and information on member resources such as a member portal ] Read this Member Handbook to learn more about health care language assistance services
Find a provider | Medi-Cal Managed Care Health Care Options Test Search for providers near you When you enroll in (join) a medical plan, you must choose a primary care provider (PCP) Your PCP is the doctor or clinic you go to when you are sick or need a checkup Select a program to search for doctors, dentists, hospitals, medical clinics, and dental clinics near you Need help choosing a program?
Request for Temporary Medical Exemption from Plan Enrollment Form This information will be used by the Medi-Cal program, its employees, and contractors only • If you have any questions about the following form, please call Health Care Options at 1-800-430-4263 HCO 7101 MA_0004048_ENG2_0715 State of California - Health and Human Services Agency Department of Health Care Services
Medi-Cal Choice Form for Los Angeles County - California Mail form back to: California Department of Health Care Services P O Box 989009 • W Sacramento, CA 95798-9850 Use this form to join or change plans For help, call 1-800-430-4263 Please print Fill in the ovals to indicate your choice