Health Net Simple Value Copay PPO Plans
There are three plans to choose from in this category, the SimpleValue 50, SimpleValue 40 and the SimpleValue 30. All these plans are identical, except for the amount they require for an office visit copayment and the coinsurance percentage for all other covered services. These variances are outlined as follows:
- SimpleValue 50 Plan - Office visits are $50 and the coinsurance is 50%
- SimpleValue 40 Plan - Office visits are $40 and the coinsurance is 40%
- SimpleValue 30 Plan - Office visits are $30 and the coinsurance is 30%
The monthly premium charged for these plans decreases as your selected coinsurance amount and office visit copayment increase. All plans have no annual deductible, so you receive first-dollar benefits for all covered services. For both inpatient hospital service and outpatient surgical facilities, there is a $400 per day admission fee. You will only be required to pay this fee for a maximum of 4 days per stay. For all Simple Value plans the annual coinsurance maximum is $7,500 when using network providers and $10,000 out-of-network. Maternity coverage is not offered on these plans. There are two different levels of prescription drug benefits that you must select from when enrolling in a Simple Value Plan. The Generic Only option does just that, provides you coverage for generic drugs only, which are a $10 copayment. The Combo option provides coverage for generic drugs at $10, brand formulary at $35 and brand non-formulary at $50. There is a separate annual deductible of $750 that applies to brand name drugs only. Regardless of which plan you select, the coinsurance percentage for out-of-network care is 50% and based on customary and reasonable rate guidelines. If the amount you are charged exceeds the reasonable rate, you will be responsible for 50% of the reasonable rate, plus 100% of any amount in excess of that rate. All copayments associated with covered services under these plans will continue to apply, even after the coinsurance maximum amount of $7,500 has been met. Certain services require pre-authorization from Health Net, or the benefit amount is reduced to 50%. Services requiring pre-authorization will be outlined in your policy, which you will have 10 days to review once it is received.
The information provided on this page is subject to change and my not be current. Check with the insurance company or your insurance agent for verification of details. The information provided is for comparison purposes only and is not legally binding. Always review the plan brochure or your policy details for complete and accurate details about this policy.