History and physical exam, adult immunizations, annual mammography exams for women over age 50, blood pressure, cholesterol and/or cancer screenings, and TB screening.

Call your doctor.

Visits, examinations, treatments, and consultations.

Call your doctor. You should be seen within 10 working days from the date of your request.

Equipment such as wheelchairs or artificial limbs.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Visits in the emergency room.

Go to the nearest emergency room. Show your ID cards (BIC, CalOptima, and health network) and ask the facility to call your health network within 24 hours.

Available if your medical condition is life-threatening.

Call 911 for an emergency ambulance.

Transportation such as ambulance, litter van, or wheelchair van services is available when your medical or physical condition makes it impossible for you to use a regular bus or car.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Health or supportive care provided in the member’s home by health care professionals. Services include wound care, IV antibiotics, physical therapy, and other services that require a licensed professional and can safely be provided in the home.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

A small battery-operated device worn in or behind the ear to increase sound waves to help a deaf or hard-of-hearing person hear sounds more clearly.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Care designed to give supportive care to people in the final phase of a terminal illness with a focus on comfort and quality of life, rather than cure. The goal is to keep the patient as comfortable and pain free as possible.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Services such as acute care, critical care units or labor and delivery, including cesarean section and room and board.

Must be ordered by your doctor and authorized by your health network.

Injection used to help the body prevent or fight off a disease.

Call your doctor.

Services such as blood work, ultrasound, Computed Tomography (CT) scan or X-rays.

Must be ordered by your doctor and authorized by your health network, except in emergencies. You should receive service within 15 working days from the date your health network approved the request.

Chiropractic services, faith or spiritual healing, occupational therapy, speech therapy, podiatry or audiology.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Supplies such as diapers or feeding tubes.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

A substance used to treat a disease or to restore health.

See the CalOptima Pharmacy Directory for a list of CalOptima’s network pharmacies.

Inpatient newborn medical care provided under the mother’s coverage.

Call your child’s doctor.

Daily room and board in a 24-hour nursing facility. Length of stay is authorized by the treating doctor.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Mental or physical activities to help recovery from disease or injury. Prescriptions are limited to no longer than six (6) months.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Checkups, shots, hearing, vision, dental and other exams given to children under the age of 21. Services also include infant and child health services through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.

Call your child’s doctor.

Exercises and physical activities to help condition muscles and restore strength and movement.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Services during pregnancy and delivery, including Perinatal Support Services (PSS).

Call your doctor.

Referrals to specialists, such as Orthopedic, Neurologist, Ear, Nose and Throat.

Must be ordered by your doctor and authorized by your health network. You should be seen within 15 working days from the date your health network approved the request.

Treatment to correct a speech impairment that resulted from birth or from disease, injury or prior medical treatment.

Must be ordered by your doctor and authorized by your health network. You should receive service within 15 working days from the date your health network approved the request.

Services are provided to eligible members through Vision Service Plan (VSP).

Routine eye exam for eligible members every 24 months or as medically necessary.

When medically necessary, eyeglasses and contact lenses are covered every 24 months if you are:

1) under the age of 21;

2) an adult living in a licensed nursing home;

3) living in an Intermediate Care Facility-Developmentally Disabled (ICF-DD); or

4) pregnant and your doctor decides that not having these services will harm your baby.

Call CalOptima’s Customer Service Department to see if you are eligible for vision care services.