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Health Net Mobile

Quick Reference Guide

Registration

Health Net Mobile allows members to view plan details, provider information, a mobile ID card, utilize ProviderSearch, and Health Net contact information.

Members must register a user name and password on healthnet.com to access:

  • My Plan
  • My Provider
  • My ID Card
  • The member search found in ProviderSearch

  • Register
Provider Search

Provider Search Health Net Mobile will allow members to search for Providers using ProviderSearch. ProviderSearch provides a guest search and a member search. The member search will require login and will provide the most accurate search results.


Urgent Care Search

Users can search for Urgent Care Facilities by sliding the indicator to "On".

When the "Search Urgent Care Facilities Only" indicator is "On" the provider name search is disabled.

Users can search by Current Location, My Address, or Zip Code.

Current location will use the phones native GPS tool to perform the search My Address or Zip Code will be pre-populated if the member is logged in.

Pre login members will need to select a plan and a medical group if the plan is CA HMO.


Urgent Care Search
Search Results

Search Results Search results can be displayed either in map or list view. The default view is map.

Hovering over a search result will display basic provider information: Provider Name and the medical group the doctor is affiliated with. Medical group information will only display for HMO members.

From the map view the user can:

  • Display the provider details screen by clicking the arrow
  • Indicates the user's current location on the map
  • Get directions to the provider's location by clicking the "Directions" button
  • Directions will be given based off of the search option (current location, address, or zip code). The user can select to change the directions based off of current location, home address, or other location.

If the user clicks the list icon (top right corner) the search results are returned in a list.

The List View will display the number of results found and indicates the number of results currently being shown. If more than 20 results are returned a “Load More Results” button will display.

The list view will:

  • Group doctors by specialty
  • If a provider has multiple specialties the provider will be listed under each specialty.
  • Specialty groupings will be separated by color
  • Phone number is a clickable link that launches the phone application
  • Map is a clickable link that will launch the map and allow the user to get directions. Directions will be given based off of the search option (current location, address, or zip code). The user can select to change the directions based off of current location, home address, or other location.
  • Show detailed information about the provider

My Plan

Members can view their plan specific information and the Plan Details section provides members information such eligibility, plan name, and effective date.


My Plan
My Provider

My Provider will allow a user to see provider specific information for any member on the plan.

  • Primary Physician – for HMO members only
  • Favorites – A Health Net Mobile feature. Providers can be added by clicking the “Favorites” link in ProviderSearch

My Plan
Mobile ID Card

The My ID Card provides the user with a mobile ID card.

Clicking the flip icon will display the back of the card (front of the card if the member is on the back). If multiple members are on the policy the signed in user’s card will display first and the user will have the ability to scroll all cards or view a list of members to select a different card.


My Plan
Contact Us

Health Net Mobile will provide the user with contact information and help topics.

Contact Health Net provides users with phone numbers and a mailing address for claims. Logged in members will see contact information specific to their plan. Users who access Contact Us pre-login will see region specific information.

The Contact Health Net section also provides a help section where users can find information related to frequently asked questions (FAQs).

The help section is searchable and questions are grouped by topic. To get more information on an item select the topic and then select a question:


My Plan

Log In



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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 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 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

CA 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 co-payment, 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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