Health Net logo
PROVIDERSEARCH
PROVIDERSEARCH

The right place to find a doctor, hospital or specialist. Search based on name, location or type of provider.

Search Now 

Medicare
& Medicaid
Medicare and Medicaid

Health Net makes choosing quality and cost-effective health care coverage simple.

Medicare Advantage 
Medicare Supplement 
Health Net Access, AZ 
Cal MediConnect 
Medi-Cal 

NEW MEMBER WELCOME CENTER
NEW MEMBER WELCOME CENTER

Are you newly enrolled through Covered California or the Marketplace in Arizona? Our Welcome Center is just for you!

Visit now 

HEALTH NET PULSE– MEMBER BLOG
HEALTH NET PULSE- MEMBER BLOG

The latest news, articles and health tips help you get the most from your Health Net membership!

Health Net | Member Pulse Arrow

Affordable
Care Act and You
Affordable Care Act and You

Use Health Net's online guide to get what you need to know fast.


Visit Our
Road Map to Reform 

IMPORTANT
NEWS UPDATES

REDUCING HEALTH
DISPARITIES

Helping reduce racial and
ethnic health disparities

Closing the disparity gap

HEALTH LITERACY

Knowing your Health Literacy
can improve your health care.

Clear & Simple health literacy

MEDICARE
SUPPLEMENT PLANS

These plans are a great
alternative for individuals
who want more choices.
Supplement plan information 

T2X

Social media health resource
for all teens nationwide.

More about T2X

Make a Payment Now

It’s quick & easy to make a premium payment for a new or existing Individual and Family plan!

Discover a New Way to Shop for Health Coverage

Our shopping tools help make it easier to find the health plan that works for you—whether you are shopping for yourself, your family or your company. From finding doctors to plan details, you'll find the tools you need to help you make your choice for health coverage!

Shop for Health Coverage Watch this video to
find a plan that fits!



Do you need help in your language?

California Language Assistance (Non-Medicare):

Language Assistance
Assistencia de Idiomas
Language Services

MEMBERS HAVE TOTAL ACCESS
TO YOUR BENEFITS ONLINE

Health Net members have a wealth of tools, support, and valuable health tips to help you live a healthier, happier life. Take advantage of everything your Health Net policy has to offer.Member Tools & Resources



Have a health plan through Covered California, Cover Oregon or Arizona Marketplace?

Here's all you need to know about paying your premium—whether you're new to Health Net, or paying your monthly premium.Learn how to make your payment

EVERYTHING EMPLOYERS
NEED TO ENSURE
A HEALTHY WORKFORCE

Health Net’s employer tools and resources let you quickly and easily administer your company’s health plan and manage employee information. Now you can spend less time on health insurance and more time on your business.Access Employer Health Insurance Tools & Resources

A health partner you can count on every day

Log In



Disclaimer

You are now leaving Health Net's website for Medicare.gov. While Health Net believes you may find value in reading the contents of this site, Health Net does not endorse, control or take responsibility for this organization, its views or the accuracy of the information contained on the destination server.

To proceed to Medicare.gov, click 'Continue'. To stay on the Health Net website, click 'Cancel'.

If you would prefer to speak to a Health Net representative about this issue, please click here to go to our Customer Service Center page.


Cancel Continue

Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

Continue

You are now leaving HealthNet.com