Other Benefits and Services

Medical Equipment

What kinds of medical equipment are covered?

TotalCare covers certain medical supplies and equipment. This includes items like orthotics and prostheses, ostomy and urological supplies, hearing aids and more. Some medical equipment you use at home to help with daily activities and improve your quality of life may also be covered. This is called “durable medical equipment” (DME). For details on this benefit, refer to your Evidence of Coverage (Member Handbook).

Out-of-Area Coverage

We provide services to members who live in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. If you are traveling outside of these counties and need to access services, follow the directions below.

• For emergency care, call 911 or go to the nearest emergency room.
• For urgent care, go to the nearest urgent care facility.
• For medical care that is not an emergency or urgent, you must get pre-approval from the plan when you’re out of the area.
• If you are temporarily out of the service area and need kidney dialysis, the service is covered.

You do not need pre-approval, known as prior authorization, for out-of-area emergency or urgent care in the United States. If you travel outside of the country and need emergency services, TotalCare will cover your care, up to $50,000.