Valley Health Plan
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By Leslie Jablonski – Updated Jan 24, 2024
Reviewed by Christine Corsini – Fact checked by Misty Berryman
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
Valley Health Plan enrollees can choose from five tiers of coverage.
- 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 percentage of healthcare costs you pay is called “coinsurance.” The lower your coinsurance, the higher the monthly premium. So a silver plan will cost more per month than a bronze plan, a gold plan will cost more per month than a silver plan, etc.
All plans are subject to a maximum out-of-pocket limit per year, not to exceed $9,100 for 2023.
Your premium will depend on the coverage tier you select, your age, smoking status, and location.
Valley Health Plan Minimum Tier
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
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.
Free Classes
On nutrition, fitness, parenting, and a variety of chronic disease prevention and management programs.
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
Does the Valley Health Plan require me to use a care network or can I see any doctor?
The Valley Health Plan is a health maintenance organization, or HMO. And like all HMOs, you must get non-emergency care from one of the participating doctors, hospitals, and other clinics and providers in the network.
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.
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.
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.
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
We’re here to help!
To learn more about Valley Health Plan CA call us at 800-913-0172 to discuss your options with a Personal Benefits Manager.
Valley Health Plan Reviews
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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.
Great for Santa Clara folks
Very happy with my PCP and the specialists I’ve seen within her network. Great coverage as long as you’re in or near Santa Clara. Not a great choice for frequent travelers, but the local area network is terrific.
Working well for our family!
This was the best value I found on Covered California. Very good coverage for the money. You make some tradeoffs with HMOs, because you have to stay in network, but that’s the nature of the beast. They’ve been very good for my wife, myself, and our three children.
We’re especially happy with our pediatrician.
Available Plans | HSA Info | Healthshare Info | FAQS | Blog | About Us | Contact Us | Agents Needed
1001-A E. Harmony Rd #519 Fort Collins, CO 80525
Telephone: 800-913-0172
California insurance license # 0G56724
[email protected] | © 2024 - All Rights Reserved
Disclaimer: All information on this website is relayed to the best of the Company's ability, but does not guarantee accuracy. Information may be out of date. The content provided on this site is intended for informational purposes only and does not guarantee price or coverage. This site is not intended as, and does not constitute, accounting, legal, tax, and/or other professional advice. Determination of actual price is subject to Carriers.
Available Plans | HSA Info | Healthshare Info | FAQS | Blog | About Us | Contact Us | Agents Needed
1001-A E. Harmony Rd #519 Fort Collins, CO 80525
Telephone: 800-913-0172
California insurance license # 0G56724
[email protected] | © 2024 – All Rights Reserved
Disclaimer: All information on this website is relayed to the best of the Company’s ability, but does not guarantee accuracy. Information may be out of date. The content provided on this site is intended for informational purposes only and does not guarantee price or coverage. This site is not intended as, and does not constitute, accounting, legal, tax, and/or other professional advice. Determination of actual price is subject to Carriers.
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