Product Portfolio
Choose from two packages that offer multiple plans.
2019 Small Business Group Plans – California
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 |
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 |
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 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 |
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.