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Product Portfolio

Choose from two packages that offer multiple plans.


Full HMO, WholeCare HMO, SmartCare HMO, and Salud HMO y Más1

Available through Health Net of California, Inc.

Pair any of our HMO Platinum, Gold or new Silver plan designs, with any of the networks we offer in your location, whether WholeCare HMO, SmartCare HMO, Salud HMO y Más or Full HMO. The plan design stays the same regardless of network. SmartCare HMO and Salud HMO y Más come with our new Advanced Choice Pharmacy Network. It includes many pharmacies like CVS, Safeway, Costco and Vons. Not included: Walgreens. Adding convenience, our HMO plans feature access to CVS MinuteClinics for walk-in medical services and preventive care.

 

Platinum $10

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$2,000/$4,000
Office/
Specialist visit
$10/$30
Outpatient surgery
(ASC/hospital)
$40/$100
Emergency
Room facility
$100
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$30/$50/30%2
 

Platinum $20

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$3,000/$6,000
Office/
Specialist visit
$20/$40
Outpatient surgery
(ASC/hospital)
$200/$500
Emergency
Room facility
$150
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$30/$50/30%2
 

Platinum $30

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$2,250/$4,500
Office/
Specialist visit
$30/$50
Outpatient surgery
(ASC/hospital)
$150/$150
Emergency
Room facility
$250
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$20/$30/30%2
 

Gold $30

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$5,000/$10,000
Office/
Specialist visit
$30/$50
Outpatient surgery
(ASC/hospital)
$360/$900
Emergency
Room facility
$300
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$50/$70/30%2
 

Gold $35

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$6,000/$12,000
Office/
Specialist visit
$35/$55
Outpatient surgery
(ASC/hospital)
$480/$1,200
Emergency
Room facility
$300
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$50/$70/30%2
 

Gold $40

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$6,000/$12,000
Office/
Specialist visit
$40/$60
Outpatient surgery
(ASC/hospital)
$440/$1,100
Emergency
Room facility
$300
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$50/$70/30%2
 

Silver $50

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$7,350/$14,700
Office/
Specialist visit
$50/$70
Outpatient surgery
(ASC/hospital)
40%/50%
Emergency
Room facility
50%
Pharmacy - Rx brand
deductible
$300/$600
Pharmacy - Rx drug tier
1/2/3/4
$20/50%/50%/50%2

CommunityCare HMO1

Available through Health Net of California, Inc.

We continue to offer our CommunityCare Silver and Gold level plans, and are introducing a CommunityCare Bronze level plan for employers in Los Angeles and Orange counties. These HMO designs come with our locally based CommunityCare network and the convenience of CVS MinuteClinics for walk-in medical services and preventive care. CommunityCare HMO also comes with our new Advanced Choice Pharmacy Network. It includes many pharmacies like CVS, Safeway, Costco and Vons. Not included: Walgreens.

 

Gold $5

Member(s) Responsibility

Deductible
(single/family)
$1,500/$3,000
Out-of-pocket
Maximum
(single/family)
$6,500/$13,000
Office/
Specialist visit
1st visit $03/$303
Visit 2+ $53/$303
Outpatient surgery
(ASC/hospital)
20%/30%
Emergency
Room facility
$200
Pharmacy - Rx brand
deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$10/$40/$60/30%2
 

Silver $20

Member(s) Responsibility

Deductible
(single/family)
$2,250/$4,500
Out-of-pocket
Maximum
(single/family)
$7,350/$14,700
Office/
Specialist visit
1st visit $03/$453
Visit 2+ $203/$453
Outpatient surgery
(ASC/hospital)
40%/50%
Emergency
Room facility
$300
Pharmacy - Rx brand
deductible
$200/$400
Pharmacy - Rx drug tier
1/2/3/4
$203/$60/$70/50%2
 

Bronze $45

Member(s) Responsibility

Deductible
(single/family)
$3,750/$7,500
Out-of-pocket
Maximum
(single/family)
$7,350/$14,700
Office/
Specialist visit
$45/$60
Outpatient surgery
(ASC/hospital)
50%/50%
Emergency
Room facility
50%
Pharmacy - Rx brand
deductible
$3,750/$7,500
Integrated
medical Rx
deductible
Pharmacy - Rx drug tier
1/2/3/4
$153/$50/50%/50%4

PPO1

Available through Health Net Life Insurance Company and Covered California™

Competitively priced, Health Net Life Insurance Company’s PPO insurance plans are a perfect fit for groups that want to offer their employees choice and flexibility. Employees can go directly to our broad PPO network of doctors and hospitals. Or they can see a doctor and use covered services outside the network. Out-of-pocket costs are generally lower when using the PPO network.

 

Platinum 90 PPO
0/15 + Child Dental

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$3,350/
$6,700
Coinsurance 10%
Office/
Specialist visit
$15/$30

Outpatient surgery
(ASC/hospital)
10%/10%

Emergency
Room facility
$150

Pharmacy - Rx deductible
(single/family)
$0

Pharmacy - Rx drug tier
1/2/3/4
$5/$15/
$25/10%2
 

Platinum 90 PPO
250/15 + Child Dental5

Member(s) Responsibility

Deductible
(single/family)
$250/$500
Out-of-pocket
Maximum
(single/family)
$3,600/
$7,200
Coinsurance 10%
Office/
Specialist visit
$153/$303
Outpatient surgery
(ASC/hospital)
10%/10%
Emergency
Room facility
10%
Pharmacy - Rx deductible
(single/family)
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$30/
$50/10%2
 

Gold 80 PPO
0/30 + Child Dental

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$7,200/
$14,400
Coinsurance 20%
Office/
Specialist visit
$30/$55
Outpatient surgery
(ASC/hospital)
20%/20%
Emergency
Room facility
$325
Pharmacy - Rx deductible
(single/family)
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$55/
$75/20%2
 

Gold 80 Value PPO
1000/30 + Child
Dental Alt5

Member(s) Responsibility

Deductible
(single/family)
$1000/
$2,000
Out-of-pocket
Maximum
(single/family)
$7,200/
$14,400
Coinsurance 30%
Office/
Specialist visit
$303/$503
Outpatient surgery
(ASC/hospital)
30%/30%
Emergency
Room facility
30%
Pharmacy - Rx deductible
(single/family)
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$30/
$50/30%2
 

Gold 80 Value PPO
750/10 + Child
Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$750/
$1,500
Out-of-pocket
Maximum
(single/family)
$7,150/
$14,300
Coinsurance 30%
Office/
Specialist visit
$103/$30
Outpatient surgery
(ASC/hospital)
20%/30%
Emergency
Room facility
$250
Pharmacy - Rx deductible
(single/family)
$750/$1,500
Integrated med/
Rx drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$103/$25/
$50/30%2
 

Silver 70 PPO
2000/45 + Child
Dental

Member(s) Responsibility

Deductible
(single/family)
$2,000/
$4,000
Out-of-pocket
Maximum
(single/family)
$7,550/
$15,100
Coinsurance 20%
Office/
Specialist visit
$453/$803
Outpatient surgery
(ASC/hospital)
20%3/20%3
Emergency
Room facility
$3503
Pharmacy - Rx deductible
(single/family)
$200/$400
All drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$15/$55/
$85/20%2
 

Silver 70 Value PPO
2000/55 + Child
Dental Alt5

Member(s) Responsibility

Deductible
(single/family)
$2,000/
$4,000
Out-of-pocket
Maximum
(single/family)
$7,350/
$14,700
Coinsurance 40%
Office/
Specialist visit
$553/$753
Outpatient surgery
(ASC/hospital)
40%/40%
Emergency
Room facility
40%
Pharmacy - Rx deductible
(single/family)
$300/$600
Pharmacy - Rx drug tier
1/2/3/4
$153/$65/
$85/40%2
 

Silver 70 Value PPO
1700/30 + Child
Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$1,700/
$3,400
Out-of-pocket
Maximum
(single/family)
$7,150
/$14,300
Coinsurance 40%
Office/
Specialist visit
$303/$75
Outpatient surgery
(ASC/hospital)
30%/40%
Emergency
Room facility
$300
Pharmacy - Rx deductible
(single/family)
$1,700/$3,400
Integrated med/
Rx deductible
Pharmacy - Rx drug tier
1/2/3/4
$153/$55/
$85/40%2
 

Silver 70 HDHP
1350/40 +
Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$1,350/
$2,700
Out-of-pocket
Maximum
(single/family)
$6,550/
$13,100
Coinsurance 30%
Office/
Specialist visit
$40/$60
Outpatient surgery
(ASC/hospital)
20%/30%
Emergency
Room facility
30%
Pharmacy - Rx deductible
(single/family)
$1,350/$2,700
Integrated med/
Rx all drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$19/$40/
$60/30%2
 

Bronze 60 PPO
6300/75 + Child
Dental

Member(s) Responsibility

Deductible
(single/family)
$6,300/
$12,600
Out-of-pocket
Maximum
(single/family)
$7,550/
$15,100
Coinsurance 100%6
Office/
Specialist visit
$757/$1057
Outpatient surgery
(ASC/hospital)
100%6/100%6
Emergency
Room facility
100%6

Pharmacy - Rx deductible
(single/family)
$500/$1,000
All drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
100%8
 

Bronze 60 HDHP
PPO 5600/15 +
Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$5,600/
$11,200
Out-of-pocket
Maximum
(single/family)
$6,550/
$13,100
Coinsurance 20%
Office/
Specialist visit
$15/$30
Outpatient surgery
(ASC/hospital)
10%/20%
Emergency
Room facility
20%
Pharmacy - Rx deductible
(single/family)
$5,600/$11,200
Integrated med/
Rx all drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$5/$15/
$40/20%4

EnhancedCare PPO1

Available through Health Net Life Insurance Company and Covered California™ Health Net of California, Inc. EnhancedCare PPO

EnhancedCare PPO gives members the best of PPO and HMO coverage – combining the choice and flexibility of a PPO with the care navigation and support of an HMO. By bringing a tailored network design to the PPO experience, this new plan's price point makes a difference for your customers' bottom line. EnhancedCare PPO comes with our new Advanced Choice Pharmacy Network. It includes many pharmacies like CVS, Safeway, Costco and Vons. Not included: Walgreens. Our specialized, expert Health Benefit Navigator team is an exclusive feature of EnhancedCare PPO that delivers 360° resolution, direct call back numbers to reach reps, and no homework for members. This gives members a real copilot for their health. Members may reach their dedicated Health Benefit Navigator team at 1-844-463-8188.

EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$250/$500
Out-of-pocket
Maximum
(single/family)
$3,600/
$7,200
Coinsurance 10%
Office/
Specialist visit

$153/$303
Outpatient surgery
(ASC/hospital)
10%
Emergency
Room facility
10%
Pharmacy - Rx deductible
(single/family)
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$30/
$50/10%2

EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$1,000/
$2,000
Out-of-pocket
Maximum
(single/family)
$7,200/
$14,400
Coinsurance 30%
Office/
Specialist visit

$303/$503
Outpatient surgery
(ASC/hospital)

30%
Emergency
Room facility

30%
Pharmacy - Rx deductible
(single/family)

$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$30/
$50/30%2

EnhancedCare PPO
Gold Value5

Member(s) Responsibility

Deductible
(single/family)
$750/
$1,500
Out-of-pocket
Maximum
(single/family)
$7,150/
$14,300
Coinsurance 30%
Office/
Specialist visit
$103/$30
Outpatient surgery
(ASC/hospital)
20%/30%
Emergency
Room facility
$250
Pharmacy - Rx deductible
(single/family)
$750/$1,500
Integrated med/Rx all drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$103/$25/
$50/30%2
 

EnhancedCare Silver
70 PPO 2000/55 + 
Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$2,000/
$4,000
Out-of-pocket
Maximum
(single/family)
$7,350/
$14,700
Coinsurance 40%
Office/
Specialist visit
$553/$753
Outpatient surgery
(ASC/hospital)
40%
Emergency
Room facility
40%
Pharmacy - Rx deductible
(single/family)
$300/$600
Pharmacy - Rx drug tier
1/2/3/4
$153/$65/
$85/40%2

EnhancedCare PPO
Silver Value5

Member(s) Responsibility

Deductible
(single/family)
$1,700/
$3,400
Out-of-pocket
Maximum
(single/family)
$7,150/
$14,300
Coinsurance 40%
Office/
Specialist visit
$303/$75
Outpatient surgery
(ASC/hospital)
30%/40%
Emergency
Room facility
$300
Pharmacy - Rx deductible
(single/family)
$1,700/$3,400
Integrated med/Rx
deductible
Pharmacy - Rx drug tier
1/2/3/4
$153/$55/
$85/40%2

EnhancedCare Silver
70 HDHP PPO 
1350/40 + Child
Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$1,350/
$2,700
Out-of-pocket
Maximum
(single/family)
$6,550/
$13,100
Coinsurance 30%
Office/
Specialist visit
$40/$60
Outpatient surgery
(ASC/hospital)
20%/30%
Emergency
Room facility
30%
Pharmacy - Rx deductible
(single/family)
$1,350/$2,700
Integrated med/Rx all drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$19/$40/
$60/30%2

EnhancedCare
Bronze 60 HDHP
PPO 5600/15 + 
Child Dental Alt

Member(s) Responsibility

Deductible
(single/family)
$5,600/
$11,200
Out-of-pocket
Maximum
(single/family)
$6,550/
$13,100
Coinsurance 20%
Office/
Specialist visit
$15/$30
Outpatient surgery
(ASC/hospital)
10%/20%
Emergency
Room facility
20%
Pharmacy - Rx deductible
(single/family)
$5,600/$11,200
Integrated med/Rx all drug
deductible
Pharmacy - Rx drug tier
1/2/3/4
$5/$15/
$40/20%4

PureCare HSP1

Available through Health Net Life Insurance Company and Covered California™

Health Net of California, Inc.'s PureCare HSPs (health care services plan) work much like an HMO in that members are required to have a primary care physician. What's different is that HSP members have the flexibility to self-refer to doctors and hospitals in the PureCare HSP network. There is no coverage for out-of-network services, except for urgent or emergency care, or services authorized by Health Net.

PureCare Platinum 90 
HSP 0/15 + 
Child Dental

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$3,350/
$6,700
Coinsurance 10%
Office/
Specialist visit
$15/$30
Outpatient surgery
(ASC/hospital)
10%/10%
Emergency
Room facility
$150
Pharmacy - Rx brand deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$5/$15/
$25/10%2

PureCare Gold 80
HSP 0/30 + 
Child Dental

Member(s) Responsibility

Deductible
(single/family)
None
Out-of-pocket
Maximum
(single/family)
$7,200/
$14,400
Coinsurance 20%
Office/
Specialist visit
$30/$55
Outpatient surgery
(ASC/hospital)
20%/20%
Emergency
Room facility
$325
Pharmacy - Rx brand deductible
$0
Pharmacy - Rx drug tier
1/2/3/4
$15/$55/
$75/20%2

PureCare Silver 70
HSP 2000/45 +
Child Dental

Member(s) Responsibility

Deductible
(single/family)
$2,000/
$4,000
Out-of-pocket
Maximum
(single/family)
$7,550/
$15,100
Coinsurance 20%
Office/
Specialist visit
$453/$803
Outpatient surgery
(ASC/hospital)
20%3/20%3
Emergency
Room facility
$3503
Pharmacy - Rx brand deductible
$200/$400
all drug deductible
Pharmacy - Rx drug tier
1/2/3/4
$15/$55/
$85/20%2

PureCare Bronze 60
HSP 6300/75 + 
Child Dental

Member(s) Responsibility

Deductible
(single/family)
$6,300/
$12,600
Out-of-pocket
Maximum
(single/family)
$7,550/
$15,100
Coinsurance 100%6
Office/
Specialist visit
$757/$1057
Outpatient surgery
(ASC/hospital)
100%6/100%6
Emergency
Room facility
100%6
Pharmacy - Rx brand deductible
$500/$1,000
all drug deductible
Pharmacy - Rx drug tier
1/2/3/4
100%8

Infertility benefits are available on all plans at an additional cost.

1 Counties available:
PPO: Available in all counties.
EnhancedCare PPO: Los Angeles County.
Full HMO, WholeCare HMO, PureCare HSP: All or parts of Alameda, Contra Costa, El Dorado, Fresno, Kern, Kings, Los Angeles, Madera, Marin, Merced, Napa, Nevada, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, and Yolo counties.
SmartCare HMO: All or parts of Los Angeles, Orange, Riverside, San Diego, San Bernardino, Santa Clara, and Santa Cruz counties.
Salud HMO y Más: All or parts of Kern, Los Angeles, Orange, Riverside, San Bernardino, and San Diego counties.
CommunityCare: Los Angeles, Orange and San Diego counties.
2 Maximum copayment after deductible (if any) of $250 for an individual prescription of up to a 30-day supply on Tier 4 drugs.
3 Deductible waived.
4 Maximum copayment after deductible (if any) of $500 for an individual prescription of up to a 30-day supply on Tier 4 drugs.
5 Not available through Covered California.
6 After the medical deductible has been reached, the member is responsible for 100% of the eligible charges until the out-of-pocket maximum limit is met.
7 Visits 1–3: The calendar year deductible is waived (combined between office visits, urgent care, prenatal and postnatal visits, outpatient mental health/substance abuse). Visits 4–unlimited: The calendar year deductible applies.
8 After the pharmacy deductible has been met, you pay 100% of the cost for all Tier 1, Tier 2, Tier 3, and Tier 4 drugs. Maximum after deductible of $500 for an individual prescription of up to a 30-day supply until the out-of-pocket maximum has been met.

Last Updated: 07/15/2021