Benefits and Programs

This includes preventive care (well-visits, screenings, tests, vaccines and other office visits with a primary care provider). You can get this care in person, by phone or by video. 

Emergency care is covered only at San Mateo Medical Center, without exceptions. You are responsible for full payment of emergency services received at any other hospital. If you are traveling outside the local area and need emergency or urgent care, you are not covered for those services.

Covered medicines

• Brand and generic medicines prescribed by your doctor that are in the ACE Formulary
• Non-formulary medicines that your doctor prescribes and gets prior authorization for from HPSM
• Some over-the-counter medicines may be covered if you have a doctor's prescription

Medicines not covered

• Over-the-counter medicines that do not require a doctor's prescription
• Dietary supplements
• Medicines for breast, cervical or prostate cancer
• Birth control
• Experimental medicines

Participant cost

There is a $7 co-pay for covered medicines.

Patient Assistance Program (PAP)

When a specialist physician prescribes a specialty medicine for you, you may qualify for the medicine manufacturer’s Patients Assistance Program (PAP). With a PAP  you could get the medicine at low or no cost. To learn more about the PAP and apply, talk to your doctor or specialist. 

Covered mental health services provided by your Primary Care Provider (PCP) clinic, within the scope of staff licensure, are covered under the San Mateo County ACE Program.

Exclusions: San Mateo County ACE Program does not cover specialty services given by psychiatrists, clinical psychologists or other specialized mental health professionals. Emergency psychiatric services are also not covered. These may be available through another coverage program.

One optometry exam is covered once every two years at approved ACE clinics with a referral from your PCP clinic. One pair of eyeglasses (frames and lenses) is covered up to $150 once every two years with prior authorization. Coverage to see a specialist requires a referral from your ACE PCP clinic.

ACE covers emergency dental services and associated supplies and anesthesia for emergency dental procedures. Routine dental care is excluded.

Call 1-833-846-8773 anytime, 24 hours a day–7 days a week.

A Licensed Registered Nurse (RN) will give you medical advice when you think you need urgent medical attention but you are not sure. A nurse will ask about your symptoms and tell you:

• If you need to go to Urgent Care.
• If you can wait to see your doctor (within 24 hours, three days or longer).
• How to take care of your symptoms at home.

Learn more about the Nurse Advice Line.

HPSM’s Health Promotion Unit (HPU) supports members with general health information, tips and resources to stay healthy. This unit does not offer medical advice. They connect members to wellness programs and services at no cost. This includes the Baby+Me Program, which connects pregnant people to support services such as Women, Infants and Children (WIC), Black Infant Health (BIH) and more. 

San Mateo County offers health coverage for the whole family. If you have children or other family members who do not have health coverage, you can contact the Health Coverage Unit (HCU) at your PCP clinic or enrollment location. They may be able to help your family members get health coverage.