What are the Basics?
Health Net ELECTSM (POS) is a two-tiered Point of Service plan. You choose the plan's HMO benefit level or Preferred Provider Organization (PPO) benefit level whenever you need care.
With the HMO benefit level, all your care is provided through or overseen by your Primary Care Physician.
With the PPO benefit level, you can see any specialist within the Health Net provider network without a referral any time you need care.
How Does it Work?
When you need care, you can choose to receive care at the HMO benefit level:
Call your physician group and make an appointment to see your Primary Care Physician.
Your copayment for office visits, emergency room visits, hospitalization and prescriptions depend on the plan your employer chooses.
You'll know your copayment amounts in advance - there are no surprises.
There's no paperwork so you won't have to submit claims for reimbursement.
Your Primary Care Physician must authorize all referrals to specialists.
Or, choose your PPO benefit level:
Without a referral, call any doctor or specialist in the Health Net network and receive treatment for covered services.
With PPO-level 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.
Your PPO doctor can get you authorization for covered inpatient services.
Your costs will be higher and you may need claim forms for certain services.
What are my Benefits?
HMO level - The following are common to many of our plans:
Emergency room service
X-ray and laboratory procedures
Vision and hearing examinations
Prenatal, postnatal and newborn care office visits
Outpatient mental health consultation and treatment
Health Net offers a variety of ELECT Open Access plans.
Benefit plans may vary by deductibles, copayments, coinsurance and out-of-pocket maximum amounts.
Your amount of coverage is generally higher and your out-of-pocket costs are lower with HMO-level benefits than they are with PPO-level benefits.
In general, you'll pay more for care that has been provided by a doctor other than your Primary Care Physician.
You are now leaving Health Net's web site 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.