Behavioral Health Conditions
C-SNP HMO
Champion Plus
Medicare + Medi-Cal
Enroll NowCalifornia
Chronic Special Needs Plans for Behavioral Health Conditions
Champion Health Plan offers Champion Plus plan which brings together specialized clinical support, medication coverage, and care coordination, all designed around the unique needs of members managing bipolar disorder, major depressive or paranoid disorders, schizophrenia or schizoaffective disorder.
Our care teams work directly with the beneficiary’s psychiatrist and primary care doctor to coordinate medication management, counseling referrals, care check-ins, and the full range of preventive services Champion Health Plan members count on. This plan is best for members who have both Medicare and Medi-Cal.
California Counties Available
- Imperial County
- Fresno County
- Kern County
- Los Angeles County
- Madera County
- Orange County
- Riverside County
- San Bernardino County
- San Diego County
| Doctor & Care Cost | Champion Plus |
|---|---|
| Monthly Premium | $12 |
| Deductible | None |
| MOOP | $9,250 |
| Primary Care Physician | $0 |
| Specialists | 20% |
| Diagnostic Radiology, Lab | $0 |
| Annual Wellness Visit | $0, up to one (1) annual exam |
| Dialysis | 20% |
| Urgent Care | $0 |
| Emergency Room | $115 |
| Inpatient Hospital | $1,676 |
| Outpatient Hospital | 20% |
| Plan Benefits | Champion Plus |
|---|---|
| OTC / Healthy Food / Utilities | $500 Allowance every (3) three months |
| Transportation | $0, 36 one-way plan-approved locations |
| Dental | $3000 Allowance |
| Routine Eye Exam | $0 Exam |
| Vision Eyewear (frames/lenses/contacts) | $500 Eyewear Allowance |
| Routine Hearing Exam | $0 Exam |
| Hearing Aid | $149 Aids |
| Respite | N/A |
| PERS | $0 |
| Prescription Drug Costs | Champion Plus |
|---|---|
| Tier 1 - Preferred Generics | $0 |
| Tier 2 - Non-Preferred Generics | $0 |
| Tier 3 - Preferred Brand | 25% |
| Tier 4 - Non-Preferred Brands | 25% |
| Tier 5 - Specialty Drugs | 25% (A 100-day supply is not available in Tier 5) |
| Tier 6 - Select Care | $0 |
| Insulin | $20, one-month supply $60, three-month supply |
| Plan Resources | Champion Plus |
|---|---|
| Summary of Benefits | Download |
| Over-the-Counter Catalog | Download |
| Healthy Foods Catalog | Download |
| Dental Fee Schedule | Download |
| Clinical Criteria | Download |
| Verification of Chronic Condition Form | Download |
| Health Risk Assessment Form | Download |
| Enrollment Form | Download |
| Authorization for Disclosure of Protected Health Information | Download |
| Evidence of Coverage (EOC) | Download |
| Enrollment Kit | Download |
