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  • Important: As of May 1, 2022, Medi-Cal is available to all people who are 50 years of age or older who meet all Medi-Cal eligibility criteria. Immigration status does not matter. These changes also let people keep more property and qualify for Medi-Cal. Contact the Ventura County Human Services Agency for more information. Learn more: English / Spanish

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Member Resources

Access to Protected Health Information

Individual request for access to protected health information (English and Spanish)

Advance Health Care Directive Form

You have the right to give instructions about your own health care. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. It also lets you express your wishes regarding donation of organs and the designation of your primary physician. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.

Advance Health Care Directive Form

Alternate Access Standards (AAS)

In accordance with state and federal laws and regulations to ensure members have adequate accessibility to available services, Gold Coast Health Plan (GCHP) adheres to the following time and distance standards:

  1. Primary care, both adult and pediatric: 10 miles or 30 minutes from any member or anticipated member’s residence.
  2. Specialty care (including OB/GYN), both adult and pediatric: 30 miles or 60 minutes from any member or anticipated member’s residence.
  3. Hospitals: 15 miles or 30 minutes from any member or anticipated member’s residence.
  4. Outpatient mental health (non-psychiatry): 30 miles or 60 minutes from any member or anticipated member’s residence.
  5. Pharmacy: 10 miles or 30 minutes from any member or anticipated member’s residence.

In cases where GCHP is unable to meet time and distance standards for any zip code within Ventura County, an Alternate Access Standards (AAS) request is submitted to the state Department of Health Care Services (DHCS) on an annual basis.

The approved AAS as of July 2021 are:

County: Ventura
Zip Code:
Provider Type:
Adult, Pediatric, or N/A:
Approved Max Time (minutes):
Approved Max Distance (miles):

County: Ventura
Zip Code:
Provider Type:
Adult, Pediatric, or N/A:
Approved Max Time (minutes): 110
Approved Max Distance (miles):

County: Ventura
Zip Code: 93252
Provider Type: PCP
Adult, Pediatric, or N/A: Pediatric
Approved Max Time (minutes): 110
Approved Max Distance (miles): 85

If your zip code and provider type are listed, you have a right to call GCHP's Member Services Department at 1.888.301.1228, TTY 711 for help finding an appointment with a specialist that is closer to you. If GCHP cannot find you an appointment with a specialist that is closer to you, GCHP will arrange transportation for you to see the specialist.

Contracted Hospitals

Los Robles Hospital and Medical Center
215 W. Janss Road
Thousand Oaks, CA 91360

Ojai Valley Community Hospital (CMH)
1306 Maricopa Highway
Ojai, CA 93023

Santa Paula Hospital (VCMC)
825 N. 10th St.
Santa Paula, CA 93060

Simi Valley Hospital and Health Care Services
2975 N. Sycamore Drive
Simi Valley, CA 93065

St. John's Pleasant Valley Hospital
2309 Antonio Ave.
Camarillo, CA 93010

St. John's Regional Medical Center
1600 N. Rose Ave.
Oxnard, CA 93030

Ventura County Medical Center (VCMC)
3291 Loma Vista Road
Ventura, CA 93003

Grievance and Appeals

Gold Coast Health Plan's (GCHP) grievance and appeals process provides a mechanism for members to report complaints regarding their health care benefits. Please use the Member Grievance & Appeals Form to submit your complaint.

Submit your completed forms to:

Gold Coast Health Plan
Attn: Member Grievance & Appeals
P.O. Box 9176
Oxnard, CA 93031

Human Services Agency

The County of Ventura Human Services Agency provides a broad array of services that include the protection of children and vulnerable adults and support for those needing assistance with food, housing, healthcare and employment. Access the Medi-Cal site.

Mammography Services

Mammogram services are a free benefit for Gold Coast Health Plan (GCHP) members. A mammogram is an X-ray used to check breasts for breast cancer. Mammograms play a key role in finding breast cancer in its early stages. Finding cancer early can help give you a head start on treatment.

Talk to your doctor about ordering your screening. For a list of contracted imaging centers for mammograms, click here.

Member Authorization Form

Member authorization form (English and Spanish)

Member Handbook

This Member Handbook tells you about your coverage under GCHP. Please read it carefully and completely. It will help you understand and use your benefits and services. It also explains your rights and responsibilities as a member of GCHP. If you have special health needs, be sure to read all sections that apply to you.

This Member Handbook is also called the Combined Evidence of Coverage (EOC) and Disclosure Form. It is a summary of GCHP rules and policies and based on the contract between GCHP and state Department of Health Care Services (DHCS). If you would like more information, call GCHP at 1-888-301-1228. If you use a TTY/TDD, call 1-888-310-7347 or 711.

2022 Member Handbook (English and Spanish)

2022 Member Handbook Changes

On April 1, 2022, information about the Postpartum Care Extension Program was updated. New information about Rapid Whole Genome Sequencing also has been included. Both changes are under Section 4: Benefits and services:

Medi-Cal benefits covered by GCHP

Outpatient (ambulatory) services

The Provisional Postpartum Care Extension Program has been replaced with the new Postpartum Care Extension Program.

The Postpartum Care Extension Program

The Postpartum Care Extension Program provides extended coverage for Medi-Cal members during both the pregnancy and after pregnancy.

The Postpartum Care Extension Program extends coverage by GCHP for up to 12 months after the end of the pregnancy regardless of income, citizenship, or immigration status and no additional action is needed.

Rapid Whole Genome Sequencing

Rapid Whole Genome Sequencing (rWGS), including individual sequencing, trio sequencing for a parent or parents and their baby, and ultra-rapid sequencing, is a covered benefit for any Medi-Cal member who is one year of age or younger and is receiving inpatient hospital services in an intensive care unit. rWGS is an emerging method of diagnosing conditions in time to affect ICU care of children one year of age or younger. If your child is eligible for California Children’s Services (CCS), CCS may be responsible for covering the hospital stay and the rWGS.

On July 1, 2022, information about a new service was added. Information about cognitive health assessments can be found under Section 4: Benefits and services.

3. How to get care

Sensitive care

Minor consent services

You may only get the following services without your parent or guardian’s permission if you are 12 years old or older:

  • Outpatient mental health care for (minors age 12 or older):
    • Sexual assault (no lower age limit)
    • Incest
    • Physical assault
    • Child abuse
    • When you have thoughts of hurting yourself or others (minors age 12 or older)
  • HIV/AIDS prevention / testing / treatment
  • Sexually transmitted infections prevention / testing / treatment
  • Substance use disorder treatment services (minors age 12 or older). For more information see “Substance use disorder treatment services” in this handbook.

If you are under 18 years old, you can go to a doctor without permission from your parents or guardian for these types of care:

  • Pregnancy
  • Family planning / birth control
  • Abortion services

For pregnancy testing, family planning services, birth control, or sexually transmitted infection services, the doctor or clinic does not have to be part of the GCHP network. You can choose any Medi-Cal provider and go to them for these services without a referral or pre-approval (prior authorization). Services from an out-of-network provider not related to sensitive care may not be covered. For help finding a doctor or clinic giving these services, or for help getting to these services (including transportation), you can call 1-888-301-1228. If you use a TTY/TDD, call 1-888-310-7347 or 711.

Minors can talk to a representative in private about their health concerns by calling the 24/7 Advice Nurse Line at 1-805-437-5001 or toll free at 1-877-431-1700. If you use a TTY/TDD, call 711.

4. Benefits and services

What your health plan covers

This chapter explains your covered services as a member of GCHP. Your covered services are free as long as they are medically necessary and provided by an in-network provider. You must ask us for pre-approval (prior authorization) if the care is out-of-network except for sensitive services, emergencies and some urgent care services. Your health plan may cover medically necessary services from an out-of-network provider. But you must ask GCHP for pre-approval (prior authorization) for this. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduces severe pain from a diagnosed disease, illness or injury. For Members under the age of 21, Medi-Cal services include care that is medically necessary to fix or help relieve a physical or mental illness or condition. For more details on your covered services, call 1-888-301-1228. If you use a TTY/TDD, call 1-888-310-7347 or 711.

Members under 21 years old get extra benefits and services. Read Chapter 5: Child and youth well care for more information.

Some of the basic health benefits GCHP offers are listed below. Benefits with a star ( * ) may need pre-approval.

  • Acupuncture
  • Acute (short-term treatment) home health therapies and services*
  • Adult immunizations (shots)
  • Allergy testing and injections
  • Ambulance services for an emergency
  • Anesthesiologist services
  • Asthma prevention
  • Audiology*
  • Behavioral health treatments*
  • Cardiac rehabilitation
  • Chiropractic services*
  • Chemotherapy & Radiation therapy
  • Cognitive health assessment
  • Dialysis / hemodialysis services
  • Durable medical equipment (DME)*
  • Emergency room visits
  • Enteral and parenteral nutrition*
  • Family planning office visits and counseling (you can go to a non-participating provider)
  • Habilitative services and devices*
  • Hearing aids
  • Home health care*
  • Hospice care*
  • Inpatient medical and surgical care*
  • Lab and radiology*
  • Long-term home health therapies and services*
  • Maternity and newborn care
  • Major organ transplant*
  • Occupational therapy*
  • Orthotics/prostheses*
  • Ostomy and urological supplies
  • Outpatient hospital services
  • Outpatient mental health services
  • Outpatient surgery*
  • Palliative care*
  • PCP visits
  • Pediatric services
  • Physical therapy*
  • Podiatry services*
  • Pulmonary rehabilitation
  • Rapid Whole Genome Sequencing
  • Rehabilitation services and devices*
  • Skilled nursing services
  • Specialist visits
  • Speech therapy*
  • Surgical services
  • Telemedicine / Telehealth
  • Transgender services*
  • Urgent care
  • Vision services*
  • Women’s health services

Medi-Cal benefits covered by GCHP

Outpatient (ambulatory) services

Cognitive health assessments

GCHP covers an annual brief cognitive health assessment for members who are 65 years of age or older and are otherwise not eligible for a similar assessment as part of an annual wellness visit under the Medicare Program. A cognitive health assessment looks for signs of Alzheimer’s disease or dementia.

Member Rewards

Gold Coast Health Plan (GCHP) values the health of its members. To encourage healthy behavior, GCHP offers incentives to members who complete these preventive care exams:

  • Annual Well-Care Exam. Members 3 through 21 years of age who have a well-care visit in 2022 can receive a $20 gift card. Download the form. Read more about well-care visits with GCHP's guide, Well-Care Visits: What to Expect (English and Spanish).
  • Asthma Exam. Members 5 through 64 years of age who have an asthma exam in 2022 can receive a $40 gift card. Download the form.
  • Cervical Cancer Screening. Members 21 through 64 years of age who have a cervical cancer screening (Pap test) in 2022 can receive a $25 gift card. Download the form.
  • Postpartum Care Exam. This member reward is no longer available as of December 31, 2019.

To learn more, view the Member Rewards flyer. (English and Spanish)

Newborn Referral Form

Notice of Privacy Practices

Notice of privacy practices (English and Spanish)

Primary Care Provider Selection Form

Primary care provider selection form (English and Spanish)

Provider Directory

Tri-Counties Regional Center

Tri-Counties Regional Center (TCRC) helps people with developmental disabilities of any age with services and support for living, working, learning and recreating in our community.

If you are receiving TCRC services and need help with getting care for a medical problem, talk to your Primary Care Provider (PCP). Your PCP can ask Gold Coast Health Plan's (GCHP) Care Management nurses to work with TCRC and the PCP to help ensure your care needs are met.

TCRC offices in Ventura County:

2401 E. Gonzales Road, Suite 100
Oxnard, CA 93036
1.805.485.3177 or 1.800.664.3177
Fax 1.805.988.9521

Simi Valley
1900 E. Los Angeles Ave., Second Floor
Simi Valley, CA 93065
1.805.522.8030 or 1.800.517.2524
Fax 1.805.522.8142

Access the Tri-Counties Regional Center website.