Health Net California HMO Plans
Health Net offers two individual HMO plans in the state of California: the HMO 15 and the HMO 40. HMO plans are a preferred plan choice for persons that have a primary care physician with whom they entrust their health care choices and want a comprehensive medical plan with little out-of-pocket costs, other than the monthly premium. Most services for medical care under an HMO plan require your contribution of only a minimal copayment and you do not need to worry about coinsurance percentages on unknown health care costs. When using a Health Net HMO Plan, all health care must be coordinated through your primary care physician who will refer you to specialists within his participating physician group when he feels that your medical condition or symptoms can best be treated through expertise in that specific medical field. Health Net in California has more than 26,000 physicians that accept their HMO Plans, or are part of a participating physician group that has an HMO contract with Health Net. HMO plans have no lifetime maximum benefit. Out-of-state coverage is limited to emergency medical situations only.
Health Net California HMO 15 Plan
Of the two Health Net HMO plans, this one is the most expensive, but also offers the lowest copayments for covered medical expenses. Many services are provided at a $15 copayment, including office visits, specialist consultations, annual physical exams, immunizations and cancer screenings. There is a $1,000 annual deductible that applies only to inpatient hospital services. The calendar year out-of-pocket maximum is $3,000 for a single person and $6,000 for families. For out-patient surgery there is a $250 copayment only. The only coinsurance requirements on this plan apply to durable medical equipment, for which you will pay 50%. Emergency room visits are $75 if you seek treatment through this venue and are not admitted into the hospital. Home health services are limited to 100 four hour visits per year. Treatment for chemical dependency is not offered under this plan, with the exception of inpatient detoxification, which requires a copayment of $100 per day. Maternity care in the hospital is covered, including delivery, after the annual hospital deductible has been met. There is a $100 deductible fro all prescription drugs, after which you will pay $15 for generic, $25 for brand formulary and $50 for brand non-formulary.
Health Net California HMO 40 Plan
As the lower priced of the two Health Net HMO plan in California, this requires higher copayments of $40 of physician visits are preventive health care. The annual deductible in $1,500, but the annual co-payment maximum is the same as the HMO 15 plan. Skilled nursing facility care is $50 per day and limited to 100 days per year. Both ground and air ambulance is $80 and emergency room care is $100. Prescription drug cover is the same as that offered under the more expensive HMO plan and smoking cessation drugs are available at a 50% discount if you are enrolled in a smoking cessation support program. You may add dental and vision benefits to this HMO plan for an small additional monthly fee. Diabetic equipment is covered for a $25 copayment and includes blood glucose monitors, insulin pumps and podiatric devices. Lab and x-ray procedures are covered at 100%, both inpatient and outpatient.
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.