A managed indemnity plan combines both traditional fee-for-services coverage and managed care. Patients pay a set percentage of the doctor's or other provider's allowable fee for each service performed, plus there are review processes so that expenditures and utilization can be managed efficiently.
What are the Basics? With this Point of Service plan, you can choose between our Preferred Provider Organization (PPO) and Out-of-Network benefit levels every time you need care.
Flex Net is a managed indemnity, or fee-for-service, insurance product.
It allows members the freedom to seek covered services from any licensed provider.
How Does it Work?
Without a referral, call any licensed physician or specialist.
Your costs will be higher and you may need claim forms for certain services.
Flex Net generally provides coverage for members who live outside the Health Net service area and cannot enroll in one of Health Net's core medical plans such as HMO, SELECT, OPTIONS PPO or ELECT.
Flex Net also provides coverage for eligible California-based retirees who reside outside the Health Net service area.
Certain services require authorization in advance through Health Net's Treatment Review program. Consult your Disclosure Form or Evidence of Coverage for more information.
With Out-of Network coverage, members generally pay a deductible and coinsurance.
A deductible is the dollar amount you must pay toward medical expenses each calendar year before coverage begins.
Coinsurance is the percentage of covered expenses for which you are responsible.
What are my Benefits?
All Flex Net plans offer basic, inpatient and emergency services.
Deductibles, coinsurance and other services may vary by plan.
The following benefits are common to all Flex Net plans:
Coverage for physician office visits (after a calendar year deductible is satisfied)
Coverage for hospital services visits (after a calendar year deductible is satisfied)
Coverage for emergency room service (in addition to the calendar year deductible)
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