Valley Health Plan
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By Leslie Jablonski – Updated May 14, 2025
Reviewed by Christine Corsini – Fact checked by Misty Berryman
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All About Valley Health Plan in California
Valley Health Plan in California was founded in 1985 and is available to residents of Santa Clara, San Benito, and Monterey Counties.
Originally created to serve a few thousand area public employees, Valley Health Plan is now the primary medical plan choice for more than 200,000 households throughout the region.
In addition to individual major medical insurance, Valley Health Plan offers group health care solutions for area businesses, a Medi-Cal managed care partnership, and a variety of county-sponsored health access initiatives.
Valley Health Plan Membership Tiers
Minimum
Catastrophic-only policy.
Bronze
Covers 60% of health costs after your deductible. You pay 40%.
Silver
Covers 70% of health costs after your deductible. You pay 30%.
Gold
Covers 80% of healthcare costs after your deductible. You pay 20%.
Platinum
Covers 90% of healthcare costs after your deductible. You pay 10%.
The Valley Health Plan Minimum coverage tier is designed for people with significant savings who can afford a high deductible, who only want to protect against potential catastrophic medical incidents, and who want to keep their premiums as low as possible.
The plan’s deductible is very high: $9,100 for an individual, and $18,200 for a family plan. However, the plan covers 100% of your healthcare expenses after you meet those deductibles.
You should only consider the Minimum plan tier if you are confident you can afford to pay at least the $9,100 deductible as a single individual, or the $18,200 deductible for family plans.
Valley Health Plan Member Benefits
Valley Health Plan members have prescription medication coverage. Mental health services are also included. Members do not need a referral to see a mental health specialist for counseling services.
For psychiatric services, however, members need a referral from their primary care doctor.
For all plans, members get access to:
$0 Annual Wellness
Exams and preventative services.
Free Classes
On nutrition, fitness, parenting, and a variety of chronic disease prevention and management programs.
Mental Health Benefits
$0 co-insurance for first 3 non- preventive combined mental health/counseling visits. Deductible applies. There’s a copay of $65 for the Bronze plan, $45 for the Silver plan, $35 for the Gold plan, and $15 for the Platinum plan.
The same co-pays apply to mental health visits via MDLIVE telemedicine.
24/7/365
Phone or video chats with a real doctor with MDLIVE Telehealth
Additionally, all Valley Health Plan members have access to a 24-hour nurse assistance hotline at no charge. This is a great resource to use if you’re not sure whether your medical situation requires a visit to the ER, an urgent care clinic, or if it’s best addressed in your doctor’s office or via an MDLive telehealth visit.
Frequently-Asked Questions About Valley Health Plan
Q: Does the Valley Health Plan require me to use a care network or can I see any doctor?
Q: Do I need a referral from my primary care doctor to see a specialist?
In most cases, for non-emergency care, yes. However, female plan members can see any OBGYN specialist via self-referral without a referral.
Members can also contact Member Services to get authorization to self-refer to a mental health care provider in network without going through your primary care doctor.
Q: Can I choose my primary care doctor?
Yes, you can choose from any of the doctors who participate in the plan network. If you don’t select a doctor when you join Valley Health Plan, a primary care doctor will be assigned to you.
Q: Does Valley Health Plan include prescription drugs?
Yes, Valley Health Plan offers prescription drug benefits. If you are taking any specific prescription drugs, you should make sure the drug you need or an equivalent generic is listed on the Valley Health Plan formulary.
You need to fill prescriptions at an in-network pharmacy. However, the Valley Health Plan pharmacy network includes nationwide chains like Safeway, Walgreens, Raley’s, and Costco.
Only prescription(s) for emergent or urgent care services will be covered at an out-of-network pharmacy when a Plan Pharmacy is not available.
Q: Is there a mail order pharmacy benefit with Valley Health Plan?
Yes. Valley Health Plan has contracted with Costco to provide mail order pharmacy services. You do not have to be a Costco member to use this benefit.
Costco’s mail order pharmacy benefit allows you to choose from three shipping options:
– Standard USPS – Free
– 3 Day UPS – $10.95
– 2 Day UPS – $13.95
Ready to sign up for a Valley Health Plan?
At HSA for America, we are here to guide you through the many questions that can arise while trying to find the right health insurance plan. Our Personal Benefits Managers partner with you by taking advantage of all of the money-saving tools available, with the goal in mind saving you as much money as possible.
This professional relationship continues on after you have your health plan secured – to ensure your medical needs are being met and your money is being saved.
Valley Health Plan Reviews
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You get what you pay for
Communication is inconsistent, and it’s hard to navigate the system for anything beyond basic care. On the other hand, it is affordable, and you get what you pay for.
Happy with our plan so far
Very happy with the affordability and level of care I receive. Sometimes it’s a little hard to get in touch with support, but otherwise, it’s been a great experience.
Fantastic health plan!
The coverage is comprehensive, and claims are processed quickly without any hassle. Customer service has always been friendly and responsive. Highly recommend!
A good option for our family
They have access to a large network of healthcare providers. The customer service team is responsive and helpful whenever we have questions or issues. Though there have been minor delays in claims processing, our overall experience has been okay.
A great choice for families looking for dependable health insurance.
We are very satisfied with our experience with Valley Health Plan. The range of coverage meets our family’s diverse healthcare needs, and we find the customer support to be very accommodating. The network of medical providers is extensive, ensuring we always have access to quality care. There have been occasional administrative hiccups, but they were resolved promptly. The plan’s commitment to community health initiatives is commendable.
Satisfied with the plan
The plan excels in providing good coverage, good preventive care initiatives, personalized customer service, and transparent policies. As a member, I have confidence in the care and support provided by Valley Health Plan.
Best health insurance in the Valley
We love our Valley health plan!
We're Valley Health fans
I own a small business in Santa Clara with 20 full-time employees. I’ve been using Valley Health Plans for the last three years. Overall, my employees and I are very pleased with the overall value and the benefits they receive.
From a plan administration perspective, VHP has been very easy to deal with. If I have a billing question, I’ve been able to reach someone right away. My employees have told me the plan is very responsive to them as well. And it’s much more affordable compared to a lot of group plans.
Stellar plan all around
They really came through for us when my husband had a heart attack last year. We called 911 and my husband was transported to the nearest hospital. It was out of network, but our rep told us it would be covered since it was an emergency. Sure enough, they took care of all the bills, since we had already met our deductible for the year. We didn’t have to worry about anything except Eddie’s recovery.
Follow-up care has been great. Our primary care doctor referred us to a cardiac rehab program and the plan’s covered all that, too.
We have to drive a little further to use an in-network practice, but it’s worth it. Overall, we don’t hesitate to recommend Valley Health Plan to our friends and neighbors.
short and honest review
I’ve been with Valley Health Plan for the past 12 years. I’m going on Medcare now. Just want to write a short and honest review. I’ll go over the pros and cons.
Pros: Competitive pricing. I’ve looked at a lot of plans and they are among the most affordable for a Silver plan.
Good network, as long as you stay in the Valley.
Some good doctors in the plan.
Claims are paid promptly. The few times I had a major expense, they paid everything over my deductible.
Cons: Some people want more freedom to choose their own doctors and go out of network.
There are no in-network providers outside of the Valley. If you travel, the only care you can get without a special authorization is for emergency care. These special authorizations are very difficult to get.
If you need emergency care after hours, it can be very hard to get authorization to see an out-of-network urgent care provider.
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