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California Large Group Portfolios

Energize your 2019 large group selling season with
Health Net!

Health Net is your source for 101+ large business portfolios that perform big without the big price tag. Our 2019 Enhanced Choice (pdf) and Starting Line-Up (SLU) portfolios (pdf) deliver a strong mix of whole-health benefits and extra-value programs – making them both attractive to your clients and easy for you to sell.

What's new for 2019?
We've refreshed our portfolio benefit plans, and added new service expansions and offerings. Plus, our 2019 underwriting deals and broker bonus program will help boost your sales opportunities!

2019 Plans Products/Networks
New lean plans with $60 copayments and $7,900/$15,800 out-of-pocket maximums. Choices across all portfolio products and networks.
New rich plan designs with $10 office visits/$250 inpatient hospital copays. Choices across all portfolio products and networks.
Expanded best-selling plan design: $20 office visit/20% inpatient hospital. New for SmartCare and ExcelCare HMO networks.
Expanded: Medical and pharmacy cross-accumulation of out-of-pocket maximums. All portfolio plans and networks, with PPO HSA-compatible plans continuing cross-accumulation of medical and pharmacy deductibles and out-of-pocket maximums.

2019 Service Expansion or Offering 2019 New/Expanded Products/Networks
New $0 copayment1 telehealth with Teladoc: Teladoc providers may be used when a member's physician's office is closed or they need quick access to health care services. Share the introductory (pdf) and FAQ (pdf) materials with your clients! All portfolio plans and networks.
New Advanced Choice tailored pharmacy network: Designed for employer cost control of increasing pharmacy premiums, Advanced Choice will connect members with CVS, Walmart, Costco, Safeway, Vons and other pharmacies.2  Check here for listings. Salud HMO y Más plans.
Expanded access to convenient MinuteClinics found in CVS stores. All portfolio plans and networks.
We're expanding our mental health administration to Managed Health Network (MHN), offering more members access to this larger network of behavioral health providers. Members will receive new ID cards with this change. All PPO portfolio plans (including custom and non-portfolio plans).
Wellness Rewards Program expansion: We recently brought this program to our HMO members, and we're expanding again! The program invites our members to take their Health Risk Questionnaire, share the results with their doctor, and we'll give them a $50 gift card. Share this informative FAQ with your groups. PPO portfolio plans.

1For HSA PPO plans, deductible may apply based on coverage design.
2Excluding Walgreens.

2019 Program Details
Enhanced Choice Q1 2019 rate guarantee3 Start your selling year strong with a second year rate guarantee option! Qualified new groups can take advantage of this rate guarantee on all Enhanced Choice plans for effective dates 1/1/19 through 3/1/19.
Salud HMO y Más stand-alone offer3 Expand your sales by offering any of our budget-friendly Salud HMO y Más plans on a stand-alone basis alongside Kaiser-only groups. The number of enrolled subscribers must be equal to or greater than 15% of the eligible enrolled population in all plans or 20 subscribers, whichever is greater.
Two Ways to Win broker bonus program Our Two Ways to Win broker bonus program has been extended! You can earn a double bonus on groups sold through effective date 12/31/19. Get all the details here.

3Enhanced Choice Q1 2019 rate guarantee eligibility is determined on a case-by-case basis. Salud HMO y Más stand-alone offer group tier structure, renewal effective date, employer contribution formula and benefit plans must have plan/carrier parity. For further qualifications and important details, terms and conditions, contact your Health Net account executive.

Great portfolio values continue in 2019

  • Low-cost plans available across all portfolio products and networks: HMO, EOA, PPO, HSA-Compatible, Salud HMO y Más, SmartCare, ExcelCare.
  • Essentials to complement medical coverage: dental, vision, chiropractic, Life, wellness. Your clients can enjoy up to 2% in combined savings with our multiproduct bundling program. Groups with a minimum of 101 employees and less than 500 enrolled members pay less for medical premiums when they add dental, vision and/or Life to the quote.
  • Active&Fit Direct member-funded fitness facility discount.
  • On-demand doctor house calls: Heal offers PPO members primary, preventive and urgent care for a similar out-of-pocket cost as a doctor visit.

Get ready to sell!
Portfolio sales materials are now available on large group forms and brochures, including prospect/member open enrollment materials.

Contact your local account executive to quote us today!

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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