Although Health Net generally
specializes in small and medium
business, they do offer both an
HMO and PPO option for
individuals and families looking
for coverage. Whether you are
self-employed, between jobs, or
just looking to supplement your
employer's policies, Health Net
may have the coverage you are
looking for.
You can choose between our
Preferred Provider Organization
(PPO) and Out-of-Network benefit
levels every time you need care.
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With the PPO, you can see any
specialist within the Health Net
provider network without a
referral any time you need care.
The Out-of-Network option lets
you seek care from any
out-of-network physician or
specialist without a referral.
How does it work?
For the PPO:
Without a referral, call any
doctor or specialist in the
Health Net network and receive
treatment for covered services.
Your benefit level will be
higher, and you'll pay fewer
out-of-pocket expenses, but you
may need claim forms for certain
services.
For Out-of-Network:
Without a referral, call any
licensed physician or
specialist.
Certain services require
authorization in advance through
Health Net's Treatment Review
program. Consult your Disclosure
Form or Evidence of Coverage for
more information.
With Out-of Network coverage,
members generally pay a
deductible and coinsurance.
A deductible is the amount you
must pay toward medical expenses
each calendar year before
coverage begins.
Coinsurance is the percentage of
covered expenses for which you
are responsible.
Your costs will be highest with
this option.
What are my Benefits?
PPO level:
Health Net offers a variety of
PPO plans.
Benefit plans may vary by
deductibles, copayments,
coinsurance and out-of-pocket
maximum amounts.
Your amount of coverage is
generally higher and your
out-of-pocket costs are lower
with HMO benefits than they are
with PPO benefits.
Out-of-Network coverage:
You get comprehensive indemnity
(fee-for-service) coverage for
care provided by any licensed
physician.
Out-of-state employees of
California-based businesses can
seek care from any physician,
anywhere, at any time
Individual and Family HMO:
The HealthNet HMO option offers
members outstanding coverage at
a lower cost than the PPO
option. Members choose a Primary
Care Physician (PCP) from
HealthNet's network, and through
their relationship with that
provider all referrals and
claims are formerly processed.
There are no variable expenses,
and out-of-pocket costs remain
low.
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Health Net Plans for Arizona
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Health Net Plans for Oregon
If you have questions about
our plans, please
Contact Us. |
