Health Net Deductible PPO Plans
Health Net offers several PPO plans that have deductibles that must be met for most covered medical expenses. These include the Value Choice Plan and five options in the Simple Choice PPO plan category. All of these plans provide out-of-network benefits that give you the freedom to use any physician or health care facility of your choice. When using Health Net contracted providers, you have access to negotiated rates and lower coinsurance percentages and maximums. All Health Net PPO plans have a lifetime maximum benefit of $6 million.
Health Net Value Choice PPO Plan
This is the lowest cost individual health plan offered by Health Net in California. It is only available to individual subscribers and is designed as a catastrophic health insurance policy with limited benefits. The primary purpose of this plan is to limit financial responsibility in the event of a major medical illness or accident.
The calendar year deductible is $1,500 and there is a 25% coinsurance after the deductible, up to the annual out-of-pocket maximum of $4,000. This maximum includes the deductible. The only benefit provided without having to meet the deductible is for generic prescriptions, which require a $15 copayment. There is no coverage for brand name drugs. Offer visits are only covered after you mean the annual coinsurance maximum, at which time they are covered in full. Maternity benefits are not included in this plan, including prenatal and postnatal care. Services provided by a doctor outside of the Health Net provide network require a 50% coinsurance which is based on customary and reasonable charges.
Health Net Simple Choice PPO Plans
There are five different plans to choose from in this class, with deductibles ranging from $1,500 to $4,000. Once you have met your selected deductible, you are covered in full for most covered services. The office visits provide first-dollar benefits, are 1% of the deductible amount and are not subject to the deductible. The plan choices are Plan 15, Plan 25, Plan 35, Plan 40 and the Plan 50. The monthly premium decreases with the higher plan number that you select. Only the Plan 40 offers maternity coverage, which has no charge after you have met the associated $4,000 annual deductible. Full prescription benefits are offered on the Simple Choice plans at $5 generic, $35 brand formulary and $50 brand non-formulary. There is a $250 drug benefit deductible per year that applies to brand name drugs only. The coinsurance maximum for out-of-network services is $10,000 with a two member family maximum.
Health Net FirstChoice PPO Plan
This is a unique PPO plan that offers 100% first-dollar coverage for the first $500 of medical expenses you incur during a calendar year. This amount is per family member and once it is met, a $3,000 deductible will apply to additional medical expenses during that year. The annual coinsurance maximum under this plan is $3,750, which is met by paying the 30% coinsurance on medical expenses after you have used your first-dollar benefits and met the annual deductible. Prescription drugs are only available in generic form and require a $15 copayment. A $250 admission fee applies to hospital stays and maternity benefits are not provided.
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.