Health Care Services
HPSM covers many health care services, including:
Medications prescribed by your doctor are covered. Some medications may require prior authorization: talk to your doctor. Some over-the-counter medications may also be covered, but must be prescribed by your doctor.
HealthWorx HMO members pay a monthly fee. The amount is determined by their employer.
Share-of-cost (SOC) payments
Some services have a co-pay and others have no co-pay:
- Pregnancy and maternity care – $0
- Doctor and hospital visits (such as medically necessary home visits) – $5
- Emergency room visits – $25
Nurse Advice Line
This toll-free phone hotline is open 24 hours a day, 7 days a week. Just call 1-833-846-8773.
Registered nurses are on hand to answer questions about your symptoms. They can tell you how urgently you need to see a doctor and may give you advice for self-care at home.
Care Coordination program
Helps get your doctors and HPSM all working to give you the focus and support you need to stay healthy. Your personal Case Manager helps you set health goals and make a plan for achieving them.
For more information, visit our Care Coordination page or call 650-616-2060
HPSM’s Health Education Unit
Provides information on a range of topics and support programs, such as:
- How to quit tobacco and other similar products
- Managing your diabetes, asthma, blood pressure and more
- The Baby + Me Program, which connects pregnant women and new moms with a range of support resources – and offers participants up to $100 in Target GiftCardsTM
Free interpreter services
If your doctor does not speak your language, interpreter services are available by phone and video. Just ask your doctor to call an interpreter during your visit. In special cases, an interpreter can go to the visit with you.
Doctor’s visits by phone or video
Many providers can give you advice over the phone or see you by video. Telephone and video visits are fully covered. Call your primacy care provider (PCP) to check if they provide telephone or video visits.
Mental health and substance use
Covered by: San Mateo County Behavioral Health and Recovery Services (BHRS). Call for information about mental health providers and other specific mental health services. You can also talk to your PCP about mental health and substance use disorders issues: they will then work with BHRS to get you the help you need.
More information: Call 1-800-686-0101 TTY: 1-800-943-2833 or visit smchealth.org/bhrs