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Cal Disconnect Plan Guidebook Medicare and Medical KG 0004006 ENG 0214 Cal Disconnect Plans RIVERSIDE & SAN BERNARDINO COUNTIES IEP Dual Choice 1-877-273-IEHP (4347) (TTY: 1-800-718-4347) www.iehp.org
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How to Fill Out Cal MediConnect:

01
Gather necessary information: Before filling out the Cal MediConnect enrollment form, gather all the required information, including your personal details, contact information, income and assets information, current health insurance details, and information about your healthcare providers.
02
Access the form: Visit the official Cal MediConnect website or contact your local county eligibility worker to obtain the Cal MediConnect enrollment form. The form can typically be downloaded in a PDF format or obtained physically.
03
Read the instructions: Carefully read through the instructions provided on the Cal MediConnect enrollment form. Make sure you understand the requirements and the information being asked for in each section.
04
Provide personal details: Start by providing your full legal name, date of birth, Social Security number, and other identifying information as required. Fill in your current address, phone number, and other contact details.
05
Income and assets information: Fill in the section where you are asked about your income and assets. Include all sources of income and list your assets, such as savings, properties, or vehicles, as instructed. Ensure you provide accurate and up-to-date information.
06
Health insurance information: Provide details about your current health insurance coverage, including the type of insurance, policy number, and the dates of coverage. Make sure to attach any required documents or proof of coverage, if requested.
07
Healthcare provider information: List the names and contact information of your healthcare providers, including primary care physicians, specialists, and any other healthcare professionals you regularly visit. If you do not have a healthcare provider, indicate so on the form.
08
Review and sign: Once you have filled out all the required sections, carefully review your answers to make sure no mistakes or omissions have been made. Double-check that all the information provided is accurate and complete. Then, sign and date the form as required.

Who Needs Cal MediConnect?

01
Individuals eligible for both Medicare and Medi-Cal: Cal MediConnect is designed for individuals who are eligible for both Medicare, the federal health insurance program for people aged 65 or older, and Medi-Cal, the California state Medicaid program for low-income individuals.
02
Those seeking integrated healthcare services: Cal MediConnect is suited for individuals who want to receive integrated physical health, behavioral health, and long-term supports and services. It provides a coordinated system of care, often through a health plan, to help manage and improve overall health outcomes.
03
Individuals residing in the Cal MediConnect plan service area: Individuals who live in one of the Cal MediConnect plan's service areas are eligible for enrollment. Each county in California may offer different Cal MediConnect health plans, so individuals should check if their specific county participates in the program.
04
Those looking for additional benefits and care coordination: Cal MediConnect offers additional benefits beyond what is offered by traditional Medicare and Medi-Cal. These services may include prescription drug coverage, dental care, vision care, transportation assistance, care coordination, and more.
Overall, Cal MediConnect is suitable for individuals who are eligible for both Medicare and Medi-Cal and are seeking integrated healthcare services, additional benefits, and care coordination to meet their unique health and wellness needs.
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Cal MediConnect is a health care program that coordinates benefits between Medicare and Medi-Cal for individuals who are eligible for both programs.
Individuals who are eligible for both Medicare and Medi-Cal are required to participate in Cal MediConnect.
Cal MediConnect enrollment can be done through a health plan that offers the program. Individuals can contact the health plan directly for assistance with enrollment.
The purpose of Cal MediConnect is to simplify coordination of benefits between Medicare and Medi-Cal, improve care coordination, and provide additional services to eligible individuals.
Information such as personal details, Medicare and Medi-Cal plan information, and health care needs must be reported on Cal MediConnect.
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