Individual and Covered California Plans

Physician services may be covered but must be authorized by the Aetna CVS Health HMO member’s selected medical group. Certain Primary Care Physicians (PCPs) are contracted through John Muir Physician Network and Hill Physicians Medical Group.

At this time, this product is only available in Alameda and Contra Costa Counties.

View the 2024 Aetna CVS Health HMO Participating PCPs availability that are in-network with each Medical Group.

What are specialist services? Specialist services are services provided by physicians specializing in advanced areas such as Cardiology, Neurology, Surgery, Oncology, etc. This is different from services provided by a general PCP pediatrician. 

Physician services may be covered but must be authorized by the Trio HMO member’s selected medical group. Certain Primary Care Physicians (PCPs) are contracted through John Muir Physicians Network, Hill Physicians Medical Group, Santa Clara County IPA (SCCIPA), and Brown and Toland Medical Group.

View the 2024 Blue Shield Trio Participating PCPs availability that are in-network with each Medical Group.

What are specialist services? Specialist services are services provided by physicians specializing in advanced areas such as Cardiology, Neurology, Surgery, Oncology, etc. This is different from services provided by a general PCP pediatrician.

Kaiser HMO members must get a referral from their Kaiser primary care or specialist physician and an authorization from their health plan for any services to be covered and considered in-network at Stanford Medicine Children’s Health. You would not be able to select a Stanford Medicine Children’s Health physician as your Primary Care Physician/general pediatrician.

What are specialist services? Specialist services are services provided by physicians specializing in advanced areas such as Cardiology, Neurology, Surgery, Oncology, etc. This is different from services provided by a general PCP pediatrician.

Stanford Medicine Children’s Health and Lucile Packard Children's Hospital Stanford are in-network for hospital and specialist physician services only. Certain Stanford Medicine Children’s Health pediatricians through affiliation with Santa Clara County IPA (SCCIPA) may be selected as Primary Care Physicians.

In order to be seen at Stanford Medicine Children’s Health, your Primary Care Physician must refer you and your medical group (SCCIPA), or health plan must authorize all services provided at Lucile Packard Children's Hospital Stanford or by Stanford Medicine Children’s Health physicians.

What are specialist services? Specialist services are services provided by physicians specializing in advanced areas such as Cardiology, Neurology, Surgery, Oncology, etc. This is different from services provided by a general PCP pediatrician.

The following Primary Care Physicians (PCPs) are contracted through Santa Clara County IPA (SCCIPA)

If your health plan is not included on this list of in-network plans that means that Stanford Medicine Children’s Health does not have a contract with your plan.