Preferred Provider Organization (PPO) - Washington
What are the Basics?
With the Preferred Provider Organization (PPO) benefit level, you can see any physician or specialist within the Health Net provider network without a referral any time you need care.
The Out-of-Network benefit level lets you seek care from any out-of-network physician or specialist without a referral.
How Does it Work?
For the PPO benefit level:
Without a referral, call any doctor or specialist in the Health Net network and receive treatment for covered services.
Your benefit level will be higher and you will pay fewer out-of-pocket expenses, but you may need claim forms for certain services.
For the Out-of-Network benefit level:
Without a referral, call any licensed physician or specialist.
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 the Out-of Network benefit level, 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 costs will be highest with this option.
What are my Benefits?
Health Net offers a variety of PPO plans; benefits may vary by deductibles, copayments, coinsurance and out-of-pocket maximum amounts.
You get comprehensive indemnity, or fee-for-service, coverage for care provided by any licensed physician.
Members can seek care from any physician, anywhere, at any time.
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.