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Decision Power®: Health and Wellness: A Bridge to Healthy Actions

At Health Net, we're here to make it easier to do what you do best – identify optimal health benefit solutions for your clients. Take Decision Power for instance.

Decision Power answers the demand for long-term benefit sustainability by:

Our Decision Power Healthy Discounts program rewards our members and supports their good health. We offer discounts on many services, including:

  • acupuncture, chiropractic, massage, and nutrition counseling
  • eye exams and eyewear
  • healthy living books, magazines and videos
  • fitness club discounts
  • hearing evaluations and aids
  • emergency medical service
  • LASIK or PRK surgery
  • vitamins, herbs, supplements and health products
  • weight management

Informed consumerism – the power to choose, the knowledge to choose wisely

When it comes to quality health care decisions, everyone's different, and there's often more than one right answer. That's why members choose when and how to use Decision Power. By providing anytime access to a wide range of information, resources and support, Decision Power makes it possible to make health decisions based on individual values, situations and preferences.

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Online resources at

  • Health Risk Questionnaire (HRQ) – the gateway to ongoing recommendations and resources based on each member's unique health profile and goals. Among the highlights: Members receive email alerts on information and action steps to take based on their HRQ results.
  • Step-by-step plans for losing weight, smoking cessation and nutrition are delivered through online programs and self-help tools. Coaching support is included to facilitate lasting, healthy changes.
  • Personal Health Record (PHR) – captures the self-reported data from a member's HRQ, and any immunization and test records they enter, so they can manage and track their health. Based on the PHR, suggested next steps and things to discuss with the doctor are automatically sent to members.
  • Health Promotion Programs – Learn more about making better choices for a healthier future. The six-week program provides practical information and useful tips and tools for improving member health and well-being.
  • Medication Center – tracks prescription drug history; provides important education about drug interactions.
  • Mental health support – resources for depression, alcohol use, eating disorders, etc.
  • Tools – health trackers (cholesterol, diet, fitness), treatment cost estimator and hospital comparison reports.

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Clinician support

  • 1–on–1 consultations – Members enrolled in a condition management program can talk to the same registered nurse every time they call during business hours, and they have access to registered nurses on the Nurse24 line after hours and on weekends. Conversations are not time-limited or scripted, so our clinicians have the flexibility to help with the member's primary concern while exploring and addressing the range of issues that may be related to and complicated by it. Decision Power nurses suggest and schedule follow-up calls to make ongoing contact easy for the member.
  • 24-hour symptom management and triage support from a registered nurse on our Nurse24 line.
  • Techniques to help patients feel comfortable in talking with their doctor and expressing their values and preferences.
  • Pointers on setting achievable health goals and evaluating treatment options.
  • Ongoing guidance/support for people living with a health condition such as diabetes, asthma, heart disease, and depression.
  • The Decision Power Wellness Health Coaching program guides an individual to change unhealthy behaviors. 1-1 telephonic health coaching provide support and resources that supports the individual in changing health behaviors they are willing and ready to change. Members can work with a Wellness Health Coach for up to 12 months.
  • Specialized support from nurse case managers to help both patients and family members deal with the complexity of complicated conditions or treatments and end-stage illnesses.

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Information sharing

Decision Power functions as a data hub on an integrated IT platform with multiple channels for bringing in and sending out information. The primary gateway is our Health Risk Questionnaire (HRQ), which gives members an instant health picture and more ways to take control of their health.

Risk stratification and predictive modeling based on data analysis enables Health Net to identify and reach out to members with chronic conditions such as diabetes, heart disease, asthma and depression, and to others identified as high-risk.

Beyond data, Decision Power uses technology in combination with open-ended questions to build the big picture. The integrated database used by the clinicians and support staff reflect claims, eligibility, pharmacy, lab tests, lab results, and prior authorization data so they can quickly identify and address other health or life issues that may aggravate a condition or influence a decision.

For example, in talking with a woman who called the Nurse24 line for a migraine, the clinician would see that the member is currently pregnant and offer her enrollment in Health Net's Healthy Pregnancy program in addition to meeting her needs around the current issue at hand.

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Tobacco cessation

Quit for Life® – tobacco cessation program

Our tobacco cessation program includes the following components:

  • Coverage for any type of tobacco.
  • Up to four proactive, one-on-one counseling calls, plus unlimited calls to a Quit Coach.
  • In-depth assessment and personalized cessation plans.
  • Comprehensive member toolkit.
  • Medication support recommendations for over-the-counter and prescription drugs.
  • Ability to re-enroll if member has not successfully quit by last counseling call through six-month survey.

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For even more information, please see the Decision Power page for our prospective members.

Members have access to Decision Power through current enrollment with any of the following Health Net companies: Health Net of Arizona, Inc.; Health Net of California, Inc.; Health Net Health Plan of Oregon, Inc.; and Health Net Life Insurance Company.

For Health Net commercial members: Decision Power is not part of Health Net's commercial medical benefit plans. Also, it is not affiliated with Health Net's provider network and it may be revised or withdrawn without notice.

For Health Net Medicare Advantage members: Decision Power is part of Health Net's Medicare Advantage benefit plans. But it is not affiliated with Health Net's provider network. Decision Power services, including clinicians, are additional resources that Health Net makes available to enrollees of the above listed Health Net companies.

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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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