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Providers: Please be aware of the Medi-Cal Rx Reinstatement of Prior Authorization Requirements and Retirement of the Transition Policy for Beneficiaries 22 Years of Age and Older. Click here for more information.

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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 December 2021 are:

County: Ventura
Zip Code:
93252
Provider Type:
Nephrology
Adult, Pediatric, or N/A:
Pediatric
Approved Max Time (minutes):
145
Approved Max Distance (miles):
105

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

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
1.805.497.2727
losrobleshospital.com

Ojai Valley Community Hospital (CMH)
1306 Maricopa Highway
Ojai, CA 93023
1.805.646.1401
cmhshealth.org

Santa Paula Hospital (VCMC)
825 N. 10th St.
Santa Paula, CA 93060
1.805.933.8600
vchca.org/hospitals/santa-paula-hospital

Simi Valley Hospital and Health Care Services
2975 N. Sycamore Drive
Simi Valley, CA 93065
805.955.6000
simivalleyhospital.com

St. John's Pleasant Valley Hospital
2309 Antonio Ave.
Camarillo, CA 93010
1.805.389.5800
stjohnshealth.org

St. John's Regional Medical Center
1600 N. Rose Ave.
Oxnard, CA 93030
1.805.988.2500
stjohnshealth.org

Ventura County Medical Center (VCMC)
3291 Loma Vista Road
Ventura, CA 93003
1.805.652.6000
vchca.org/hospitals/ventura-county-medical-center

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.

2023 Member Handbook (English and Spanish)

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 2023 can receive a $25 gift card. Download the form. Read more about well-care visits with GCHP's guide, Well-Care Visits: What to Expect (English and Spanish).
  • Breast Cancer Screening: Female members 50 to 74 years of age who have a breast cancer screening (mammogram) in 2023 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 2023 can receive a $25 gift card. Download the form.

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:

Oxnard
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.