County Health Plans (CHP)
The County Health Plans (CHP) are self-funded, meaning the contributions from the County of Sonoma and eligible employees and retirees are used to pay plan benefits, including services provided to the members and claims administration.
Anthem Blue Cross is the network provider and medical plan claims administrator for both the EPO and PPO plans.
If you reside within California, services are provided through the Prudent Buyer Plan network (Blue Cross PPO Prudent Buyer - Large Group). Plan members have access to more than 60,800 doctors and specialists that make up a strong local California network. Anthem Blue Cross has contracted with more than 90% of hospitals in California, including 400 acute care hospitals.
If you reside outside of California, services are provided through BlueCard network (National PPO Blue Card PPO). More than 96% of hospitals and more than 91% of physicians across the country contract with Anthem Blue Cross through the BlueCard® program.
Need help deciding which plan is best for you? For a side by side plan comparison of the CHP EPO and PPO plans view the Medical Plan Comparison Chart.
Effective June 1, 2024
Employees
Employees will no longer be eligible to enroll in a CHP plan effective June 1, 2024. Employees enrolled prior to June 1, 2024 will be grandfathered into the plan. Once an employee leaves a CHP plan, they will no longer be eligible to return to a CHP plan.
Non-Medicare Retirees
Non-Medicare Retirees are eligible to enroll in a CHP plan.
Medicare Retirees
Retirees enrolled in Medicare will no longer be eligible to remain on a CHP plan effective June 1, 2024. Medicare retirees will need to elect another Medicare eligible plan. Available health plan providers with Medicare eligible plans include; Anthem Blue Cross, Kaiser Permanente, Western Health Advantage and UnitedHealthcare
Customer Service and Group Numbers
Customer Service
Medical Claims Administrator - Anthem Blue Cross
Customer Service:
Website:
Prescription Carrier - RxBenefits + CVS/Caremark
Customer Service:
Monday - Friday, 5:00am to 6:00pm PT
Email:
Chat with a live agent:
Login to the online portal at Member.RxBenefits.com
Monday - Friday, 7:00am to 4:00pm PT
Need to speak with a pharmacist?
Contact the Pharmacy Help Desk at (800)364-6331
Website:
EPO Group Numbers
Employee Group Numbers
Medical Plan in California
Group #175130 M116
Medical Plan Out-of-State
Group #175130 M120
RxBenefits Prescription Plan
Group #RX2169
Retiree Group Numbers
Medical Plan in California
Non-Medicare Group #175130 M118
Medical Plan Out-of-State
Non-Medicare Group #175130 M122
RxBenefits Prescription Plan
Non-Medicare Group #RX2169
PPO Group Numbers
Employee Group Numbers
Medical Plan California
Group #175130 M108
Medical Plan Out-of-State
Group #175130 M112
Prescription Plan
Group #3439-1002
Retiree Group Numbers
Medical Plan California
Non-Medicare Group #175130 M110
Medical Plan Out-of-State
Non-Medicare Group #175130 M114
RxBenefits Prescription Plan
Non-Medicare Group #RX2169
What is an EPO and PPO?
Exclusive Provider Network (EPO)
The County Health Plan EPO is an exclusive provider organization (EPO). An EPO is a great plan that offers you affordable out-of-pocket costs, with access to the doctors and hospitals you trust.
- You are free to visit any doctor or hospital in the network when you pay an affordable copay or deductible, without the hassle of filling out forms.
- Covered services must be provided by network providers.
- Most doctor and specialist office visits are available at a $50 copay and most in-network preventive services, such as well baby/child visits (up to age 18), immunizations, routine physicals, mammograms, and routine preventative screenings are covered at no cost.
- Other in-network services are covered at 80% after the deductible ($500 per individual or $1,500 per family) is met.
Preferred Provider Organization (PPO)
The County Health Plan PPO is a preferred provider organization (PPO). A PPO is a medical plan that offers you a choice between an in-network group of providers who offer their services at discounted rates and out-of-network providers without discounted rates. Under a PPO plan, you may choose the level of benefits you receive based on the providers you use when you receive care.
- Most in-network doctor and specialist office visits are available at a $20 copay and most in-network preventative services, such as well baby/child visits (up to age 18), immunizations, routine physicals, mammograms, and routine preventative screenings are covered at no cost.
Other in-network services are covered at 90% after the deductible ($300 per individual or $900 per family) is met.
Prescription Coverage by RxBenefits + CVS Caremark
Effective September 1, 2024, prescription benefits for the County Health Plans (CHP) will now be administered by RxBenefits on the CVS Caremark network. Welcome announcement and RxBenefits Plan Information.
View the Performance Drug List for a list of covered prescription medications. This list is not all inclusive, can change at any time and does not guarantee coverage.
Effective April 1, 2026, CVS Caremark has made changes to the formulary.
Prescriptions will be filled with a generic drug when available.
If a generic drug is not available, the brand name drug will be filled and you will pay the brand name copay.
If a generic drug is available but a brand name drug is medically necessary, as prescribed by your doctor, your doctor must request an exception to the plans’ mandatory generic policy through RxBenefits prior to getting the prescription filled. If the exception is approved, you will be charged the brand name copay.
If the exception is not approved or you choose the brand-name drug when a generic equivalent is available, you will be responsible for the brand name copay plus the difference between the brand name and generic cost.
If you are taking a maintenance drug, it can be filled at any retail pharmacy twice. After the second fill, it must be filled at a CVS pharmacy or by mail order through CVS/Caremark.
A Formulary Exclusion List can be found by logging into your account on CVS Caremark's website or by calling RxBenefits at 800-334-8134.
- Pharmacy Tiering Exception Request Form - Use this form to request an exception for the patient to receive the non-formulary medication at the formulary brand copay.
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