Valley Health Plan 40th Anniversary
Celebrating 40 Years with You!
This year, Valley Health Plan (VHP) is celebrating a big milestone—40 years of caring for our community! Since 1985, we have been proud to offer affordable, high-quality health coverage to people across Santa Clara County. And we could not have done it without you, our members.
VHP started as a small health plan for County workers. Today, more than 200,000 members trust us to help them stay healthy. Over the years, we have grown and changed, but one thing has stayed the same: our mission to put people first.
What This Means for You:
• A Strong Network
We work closely with doctors, clinics, hospitals, and community programs. That means you get connected care that supports your whole health, not just one part of it.
• Affordable Plans
We continue to offer competitive pricing through Covered California. This means you save money and stay covered.
• Recognized for Quality and Equity
We have earned national recognition for our focus on fair, high-quality care. This includes special honors for our work in health equity, making sure care is inclusive for you and all our members.
Looking Ahead
As we move forward, we are working to make your care easier to access, more connected, and more focused on what matters most to you and your family. We are also growing smarter, so that we can keep improving the services and care you rely on.
Thank You for Being Part of the VHP Family!
We want to say thank you for being part of our journey. You are the heart of VHP. Whether you have been with us for many years or just joined, we are so glad that you are here. Here is to the next 40 years—together.
VHP Programs for Better Health
Asthma Care at VHP: Supporting Families and Building Kids’ Confidence
This summer, Valley Health Plan made significant strides in supporting members living with asthma. Through a partnership with BREATHE CA and VHP’s Health Education Department, the Asthma Summer Camp Program provided children and their families with tools to better understand and manage asthma while having fun. On July 29, 2025, 19 children ages 6 to 12 joined VHP and our partners at BREATHE CA for a unique Asthma Summer Camp experience.
VHP is committed to health and prevention, and supporting VHP members through the Asthma Summer Camp is just another example of this.
What VHP families are saying:
• “This program is a great opportunity for children to learn about their health and feel confident in managing asthma. My son can now explain parts of the respiratory system and knows when he needs his inhaler. His self-confidence improved so much.”
• “My son loved it. He looked forward to the camp every day. The counselors encouraged him to try new things, something I usually struggle with. I have never seen him so happy to participate in anything before.”
• “Quiero darles las gracias por la inscripción. Fue un tiempo muy divertido. Nos divertimos mucho y nos vamos muy contentos.”
VHP Health Education Department is here to support your family’s health journey, providing resources, programs, and care that empower both children and parents.
To learn more about VHP's Health and Wellness programs and how to enroll, visit our website at www.valleyhealthplan.org/members/healthand-wellness.
If you have any questions, contact VHP's Health Education Department at healtheducation@ vhp.sccgov.org or 408-970-2299.
VHP’s Diabetes Prevention Program
Valley Health Plan offers the Diabetes Prevention Program for members ages 18 and older who have prediabetes. This program, in partnership with the YMCA, helps you take charge of your health and prevent type 2 diabetes. You can reverse prediabetes by making changes to your lifestyle.
In this program, you will learn how to:
• Eat healthy while still enjoying your favorite foods
• Include physical activity in your daily life, even with a busy schedule
• Manage stress effectively
• Overcome challenges, like choosing healthy foods when eating out
• Get back on track if you stray from your plan
You will receive support from a group and guidance from YMCA Lifestyle Coaches to help you reach your health goals. The program lasts for one year and aims to lower your risk of developing type 2 diabetes.
Making lifestyle changes takes time, so staying in the program for the full year is important to help you build new habits and avoid falling back into old ones. If you do not meet your goals during the first half of the program, your Lifestyle Coach and group members will help you succeed. The YMCA will also provide you with a 4-month YMCA membership at no cost. Valley Health Plan covers the cost of the Diabetes Prevention Program.
What Is Prediabetes?
Prediabetes means your blood glucose (or blood sugar) levels are higher than normal but not high enough for a type 2 diabetes diagnosis. This can lead to serious health problems such as heart disease, strokes, and type 2 diabetes. Most people do not have symptoms, so the best way to find out if you have prediabetes is to talk to your doctor about getting a blood test. Your doctor may suggest this test if you are overweight or have other risk factors.
Risk Factors for Prediabetes:
• Having a parent, brother, or sister with type 2 diabetes
• Being age 45 years or older
• Being overweight or obese
• Having gestational diabetes (diabetes during pregnancy)
• Being physically active less than 3 times a week
• Being Hispanic/Latino, Black, Asian American, or Native American
Prediabetes is a strong warning that type 2 diabetes may come next. Knowing if you have prediabetes is important so you can prevent it from getting worse. If you think you or someone you know might be at risk for diabetes, there are steps you can take to help.
To learn about more about VHP’s Diabetes Prevention Program and how to enroll, visit our website at www.valleyhealthplan.org/ members/health-and-wellness.
If you have any questions, contact VHP's Health Education Department at healtheducation@ vhp.sccgov.org or 408-970-2299.
VHP’s Doula Services
Pregnant or just had a baby? You do not have to go through it alone.
VHP now offers doula services to support you during pregnancy, birth, and the postpartum period. Having a baby is an exciting time, but it can also bring challenges. A doula is a trained professional who provides support, comfort, and guidance so that you and your family feel more confident every step of the way.
What Doulas Can Do:
• Personalized support. Whether in-person or online, doulas are there to listen, answer questions, and provide reassurance
• Labor and delivery assistance. From breathing techniques to comfort measures, doulas can help reduce stress and support your birth plan
• Postpartum care. Guidance with breastfeeding, recovery, and emotional well-being
• Support Through Loss. Compassionate care for those experiencing a miscarriage or abortion
Why Choose a Doula?
Studies show that doula support can lead to better birth experiences, including reduced need for pain medication, fewer cesarean deliveries, and improved maternal satisfaction. More importantly, you will have someone by your side who understands your wishes and advocates for you.
Who Can Use This Service?
Doula services are available at no cost for Valley Health Plan members. You do not need a referral from your doctor; just reach out when you are ready.
Get Started
To find a doula or learn more about the VHP’s Doula Services, visit VHP’s website at www. valleyhealthplan.org/doula-services. Start your journey with the support you deserve.
Health and Wellness
Are You Up to Date on Your Preventive Care?
Taking care of your health today can help you avoid serious illness tomorrow. Preventive health services, such as checkups, vaccines, and screenings, can help catch problems early and keep you feeling your best.
Preventive care includes:
• Checkups: Regular visits with your doctor to track your overall health
• Dental Care: Cleanings prevent cavities and gum disease
• Health Education & Counseling: Guidance on nutrition, exercise, quitting smoking, and more
• Initial Health Appointment: A full checkup during your first visit with your doctor
• Vaccines: Protect against diseases like flu, pneumonia, and COVID-19
Screenings for women or female assigned at birth:
• Pap test: Detects cervical cancer early https://www.cdc.gov/cervical-cancer/ screening/index.html
• Mammogram: X-ray screening that finds breast cancer when it is most treatable (ages 40-74)
Screenings for men or male assigned at birth:
• Testicular self-exam: Helps detect testicular cancer early
• Prostate cancer screening: Talk to your doctor about if this is right for you https://www.cdc.gov/prostate-cancer/ screening/get-screened.html
Screenings for everyone:
• Colorectal cancer: Screenings can find and remove precancerous growth https://www.cdc.gov/colorectalcancer/screening/index.html
• Lung cancer: Yearly screening may be recommended for adults ages 50 to 80 with a history of heavy smoking
Take Charge of Your Health
Preventive screenings are one of the most powerful ways to protect your health.
Recommendations vary by age, gender, and personal risk factors, so talk to your doctor about what is right for you. Staying current means more healthy days to enjoy with the people you love.
What is Prostate Cancer?
About one out of eight men in the U.S. will get prostate cancer during their lives. Prostate cancer is the second most common cancer in men, after skin cancer. This cancer develops in the prostate, a small gland in the male reproductive system. In prostate cancer, cells in the prostate grow uncontrollably and may spread to other parts of the body, like bones and lymph nodes.
Prostate Cancer Screening
Prostate cancer screening aims to find cancers that might spread if untreated. Most prostate cancers grow slowly or not at all. The main screening test is the prostate-specific antigen (PSA) test. This test measures the PSA levels in a person’s blood. High PSA levels may indicate a prostate issue, but they do not always mean cancer. Other conditions, like inflammation or an enlarged prostate, can also cause high PSA levels.
Questions to ask your doctor about prostate cancer:
• What are my risks for developing prostate cancer?
• What are the symptoms of prostate cancer?
• Should I wait for symptoms before getting screened for prostate cancer?
• What options do I have for prostate cancer screening tests?
• If the screening test shows cancer, will I need to confirm this with another test?
• What steps should I take if I have prostate cancer?
Men and individuals assigned male at birth should start screening at age 40. Those at higher risk, like African Americans or those with a family history of prostate cancer, should start at age 35. Contact your doctor to schedule an appointment to discuss prostate cancer.
Free Colon Cancer Screening Tests Mailed
Colon cancer is one of the most preventable cancers. It is also more treatable in 9 out of 10 people if caught early.
Valley Health Plan has partnered with Exact Sciences to offer Cologuard Test Kits for colorectal cancer screening to eligible Covered California members that are 45+ at average risk and due (or overdue) for their colon cancer screening.
This program aims to improve access to preventive screenings and help members manage their health proactively. Cologuard makes screening simple, private, and convenient.
Eligible VHP members should have received a letter or email explaining that the test is part of their health insurance benefits and comes at no cost.
If you have any questions regarding the test, please visit www.cologuard.com/why.
For assistance, please contact VHP Member Services at 1-888-421-8444 or memberservices@vhp.sccgov.org.
Stay Healthy This Season with the Flu Shot
With flu season upon us, Valley Health Plan (VHP) encourages members to get a flu vaccine. Getting vaccinated helps protect you, your family, and your community from the flu. It is one of the best ways to avoid serious illness, especially for children, older adults, and people with chronic health conditions.
Flu vaccines are covered at no cost for VHP members when received from an in-network provider or participating pharmacy.
Where to Get Your Flu Vaccine:
• Your Primary Care Provider (PCP): Call ahead to ask if an appointment is needed.
• Retail Pharmacies in the VHP Network: Many pharmacies such as Walgreens, Safeway, and others offer walk-in flu shots. Be sure to choose an in-network pharmacy.
Important Reminder:
Starting January 1, 2026, VHP members must receive flu vaccines at an in-network pharmacy to be covered.
For Children:
Children six months and older should get the flu vaccine. Ask your child’s pediatrician or check with a participating pharmacy. Please note that some pharmacies may have age restrictions for children.
When to Get Vaccinated:
The best time to get your flu shot is in the fall season, but it is still helpful to get vaccinated later in the season. The flu virus changes every year, so it is important to get a new vaccine each year.
Need Help Finding a Location?
• Log in to your VHP Member Portal at www.vhpconnect.org for a list of providers and pharmacies.
• Contact VHP Member Services at 1-888421-8444 or memberservices@vhp. sccgov.org if you need help finding a location near you.
Vaccine Advice for Flu, COVID-19, and RSV
The California Department of Public Health recommends flu, COVID-19, and RSV vaccines based on age and health. See the chart below. VHP covers these vaccines at no cost to you at any in-network pharmacy.
If you have any questions about vaccines, your health, or your child’s health, please contact your doctor or health care provider.
Source: www.cdph.ca.gov
Understanding Your Benefits
VHP Provider Directory
Our online provider directory allows you to find a doctor or hospital that best meets your needs. You can search for a provider by specific characteristics such as gender, language, location, network, or name. Start your search today by visiting www.valleyhealthplan.org and clicking on the Provider Search tab.
The Provider Directory gives general information on all contracted practitioners.
If you would like help with changing your primary care physician (PCP) or have questions about a physician, please contact Member Services at 1-888-421-8444 (toll-free) or memberservices@vhp.sccgov.org.
Coordination of benefits
Do you or any of your eligible dependents have health insurance coverage with another health plan or Medicare? If so, you must notify Valley Health Plan (VHP) of coverage in cases where medical claims may need to be coordinated for payment.
VHP does not coordinate benefits with other health insurance companies for services provided by non-contracted providers or for services that VHP has not preauthorized.
If you or your eligible dependents have other health insurance, please contact VHP Member Services at 1-888-421-8444 (toll-free) or memberservices@vhp.sccgov.org.
News and Alerts
Valley Health Plan’s Office Is Moving
Valley Health Plan will be moving to a new office on January 1, 2026. Our new address will be 5845 Hellyer Avenue, San Jose, CA 95138
You can still visit us at our 2480 North First Street office through December 31, 2025, for walk-in service.
Starting January 1, 2026, please call us first at 1-888-421-8444 before visiting us. We may be able to help you by phone. If you need inperson help, we can connect you to someone who can help you.
Your benefits and care will remain the same. The only thing changing is our office location. You can still reach us by:
• Phone: 1-888-421-8444
• Email: memberservices@vhp.sccgov.org
• Patient Portal: Send a secure message through www.vhpconnect.org
Thank you for your patience during this move. We are excited to welcome you to our new office in 2026!
Fraud Alert - COVID-19 Testing Scams
Be aware of the ongoing COVID-19 scams. Some people are using fake testing sites, phone calls, text messages, social media, and even going door-to-door to trick you. They may offer you money and COVID-19 services for your personal information, like your Medicare or Medi-Cal details. These are not real; the services are fake. Never give your personal information to strangers, especially for money. Scammers can use your details to steal your identity or scam health care programs. To stay safe, do not share your personal info with people you do not trust. Go to your trusted doctor or pharmacy for COVID-19 services.
Join Our Advisory Board to Help Inform a More Equitable Future
Do you want to positively impact the lives of other VHP members? VHP is looking for members to serve on its advisory board. The board is a group that helps VHP decide how to best serve its members. By joining, you can help ensure VHP meets its community’s needs and delivers highquality care to the members who depend on us.
The board is made up of at least 51% VHP members and meets online quarterly. Its suggestions are regularly reported to VHP’s governing body.
Become a part of our advisory board and help us shape a more fair and inclusive future. To learn more, call Member Services at 1-888-4218444 and ask to speak to the Member Services Manager about the advisory board. You can also email memberservices@vhp.sccgov.org.
Important Resources and VHP Benefits Information
At VHP, we know that keeping up on how to get the most out of your health plan is important to you. So, we have made it easy. To find all your health information in one place, access our member portal, VHP Connect, at www. vhpconnect.org
For information on the following subjects, visit: www.valleyhealthplan.org/members/ benefits-and-coverage-information-ifpmembers/benefits-and-coverage-handbooks or www.valleyhealthplan.org > Members Tab > Benefits Handbooks. The Benefits Handbooks are also known as the Evidence of Coverage (EOC). This information is also available through alternative media upon request.
Advance Health Care Directive
Affirmative Statement About Financial Incentives
Autism Care Management Program
Change of Address
Choosing and Changing Your Primary Care Provider (PCP)
Chronic Condition Management Program / Care Management
Combined Evidence of Coverage, including information such as:
• Benefits and services included and excluded from coverage
• Pharmacy management and general coverage
• Copayments and other cost sharing responsibilities
• Benefits and limitations to services outside the service area
• How to submit a claim for covered services
• How to obtain specialty care, behavioral healthcare services, and hospital services
• How to obtain care outside the service area
• How to obtain care after normal business hours
• Authorization and denial of services
• Independent Medical Review (IMR) eligibility and process
• Evaluation and coverage of new and existing technologies
Coordination of Benefits
Emergency and Urgent Care Services
Grievance and Appeals Process
Language Assistance
Lock-In Provision
Member Rights and Responsibilities
Non-Discrimination
Protected Health Information
Provider Directory / Search
Self-Refer Services (Direct Access)
Timely Access
Waste, Fraud, and Abuse
The VHP Member Services Department has staff available Monday through Friday, 8:00a.m. to 5:00p.m. to assist with:
• utilization management issues
• authorizations
• claims
• benefits
• coverage
• general inquiries
Messages received after normal business hours are returned on the next business day, and messages received after midnight Monday through Friday are responded to on the same day.
Language Assistance
As a member, VHP member services can help you in your preferred language at no cost. VHP provides over 150 languages including American Sign Language. We also offer braille and large print options upon request.
All VHP members can receive free translation and interpretation services. To access language services, translated documents, or American Sign Language assistance, please call VHP Member Services at 1-888-421-8444 (toll-free) or email us at memberservices@vhp.sccgov.org.
Teletypewriter (TTY) and Telecommunications Device for the Deaf (TDD) services are available for the hearing and speech impaired. Call the California Relay Service (CSR) by dialing 711 or the 800 CRS number of your modality.
VHP Drug Formulary
The VHP Drug Formulary is a list of covered outpatient drugs. The VHP Pharmacy and Therapeutics (P&T) Committee reviews and updates this list quarterly. They also review procedures once per year.
The P&T Committee decides:
• which drugs to add to the formulary
• which drugs need prior authorization
• if a drug has quantity limits or requires step therapy
• which drugs require therapeutic interchange
• when the use of generic, authorized generic, biosimilar, or interchangeable drug substitutions may be used
• which drugs will not be added
These choices are based on the U.S. Food and Drug Administration (FDA) approval, scientific articles, and drug safety. Choices are also made based on whether there are drugs available that accomplish similar results.
After each P&T Committee meeting or at any time, you can visit: www.valleyhealthplan. org/members/pharmacy to view the drug formulary and summary of updates. When a negative formulary change occurs that could
impact you, VHP will send a communication to you and your doctor. Please refer to the VHP Provider Manual at www.valleyhealthplan. org for more information about the VHP P&T Committee.
Prior Authorizations
When a drug is on the formulary with “PA” abbreviated under the column, “Special Code,” or the drug is not on the Formulary, then the provider must fill out a “Prescription Drug Prior Authorization” or “Step Therapy Exception Request” form. The form must be filled out completely with information that supports the request and then submitted to the pharmacy benefit manager. These forms will be reviewed by a pharmacist and/or a doctor. Approval will be based on established criteria and medical necessity.
Providers will be able to access information about VHP’s prior authorization criteria by logging into the Navitus Provider Portal with their National Provider Identifiers and selecting, “Valley Health Plan.” VHP Providers can access the links below:
• Provider Navitus Online Portal: https://prescribers.navitus.com
• VHP website: www.valleyhealthplan.org/ providers/pharmacy
VHP Members can request a drug not on the formulary by logging into the Navitus Member Portal with their Member IDs. VHP Members can access the links below:
• Member Navitus Online Portal: https:// memberportal.navitus.com/landing
• VHP website: www.valleyhealthplan.org/ providers/pharmacy
Navitus Health Solutions administers the pharmacy benefit on behalf of VHP. This includes customer service, formulary maintenance, prior authorizations, exception to coverage, and drug recall notifications. Navitus Customer Care is available 24/7 at 1-866-333-2757 (toll-free).
Copays
Copays apply to drugs prescribed by an authorized prescriber and dispensed by a Plan Pharmacy. Please refer to the Summary of Benefits and Coverage (SBC) for the copay amount for each tier. An out-of-pocket cost may
apply as described by your Summary of Benefits and Coverage (SBC). For more details, see the “Copays and Deductibles” section.
At a minimum annually, when a negative change occurs, and when there are updates, VHP communicates a summary of the pharmaceutical management procedures, P&T Committee formulary decisions, and negative formulary changes to members and to network providers. These details are in the formulary, including a list of covered Physician Administered Drugs. They are also posted on the VHP website at www. valleyhealthplan.org. Upon request, a paper copy of the procedures will be sent by mail, fax, or email.
If you would like a paper copy of any of the formulary management procedures, the VHP formulary, changes to the VHP drug formulary, or if you have questions about the formulary, please contact Navitus Customer Care at 1-866-3332757 (toll-free). For more information, you can also visit www.valleyhealthplan.org.
If you have questions or need help, please contact VHP Member Services at 1-888-4218444 (toll-free) or memberservices@vhp. sccgov.org
Complex Case Management (CCM) and the VHP Case Management Program
Taking care of your health is important, but finding support can be hard. Valley Health Plan's Case Management Program is here to help. We work one on one with our members over the telephone to help them have the healthiest lives possible. We act as advocates, assist with coordinating care, and provide health education. We provide guidance and support and can find resources to help members thrive.
The Case Management Program is voluntary and free to VHP members. All calls are confidential. Members can opt-out at any time by contacting us at the phone number below.
Contact VHP Case Management to start today at 1-669-220-5235. Our staff are available, Monday-Friday, 8a.m. to 5p.m. (Pacific Standard Time). If you use a TTY, call 711 (toll-free). We look forward to supporting you!