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Electronic Document Delivery Service Agreement

Some Registered Users may elect to enroll in Health Net's "Electronic Document Delivery" ("EDD") program.By enrolling, you agree and acknowledge the following:

  • You understand that if you enroll in electronic document delivery your consent to the terms of this "Electronic Document Delivery" section will be effective indefinitely, until you cancel electronic document delivery or it is cancelled by us.  We may cancel the EDD service at any time without prior notice.
  • You consent to receiving electronic delivery via www.healthnet.com, and to stop U.S. mail delivery, of the paper versions of all documents selected in your Document Delivery Preferences within your Health Net online profile. You understand that your electronic consent bears the same legal authority as your written signature and is binding by law.
  • You agree to maintain a valid email address with Health Net as a condition of participating in our EDD program. Unless you have elected not to receive such notifications, Health Net will send an email to the email address you have provided to notify you when a new document is available on our site and indicate the category of document. The email will provide a link to a login page on our site's secure portal. After you log in, your specific document(s) will be displayed.  If we are unable to notify you via email when a document becomes available due to a bad and/or cancelled email account, we will attempt to contact you to update your email address. If we are unable to make contact with you, we will revert your Document Delivery Preferences back to U.S. mail delivery for all document types, and send a letter notifying you of the change. You can log into www.healthnet.com and update your email address and document delivery preferences at any time.
  • You acknowledge that you may obtain a paper copy of any electronic document free of charge by contacting Health Net. In addition, you understand that you may download or print a copy of any of these documents online by logging in to your account on www.healthnet.com.
  • Except as otherwise provided herein, you understand that you may terminate electronic delivery for any category of documents or modify your email notification preferences at any time, free of charge, by clicking the Change Document Delivery Preferences link within your online profile and changing your document delivery choice to Mail (USPS) or by contacting Health Net.  Your cancellation will be effective within a reasonable period of time after we receive it.
  • For members enrolling in Health Net’s EDD program, you agree that you have full authority to accept the terms of this EDD section on behalf of each beneficiary on your plan. You also agree that each beneficiary has full authority to act individually in all matters relating to this online service.
  • For Medicare Advantage Members, you acknowledge and agree that you will maintain a valid email address during the time you are enrolled in the Health Net EDD program. Health Net will notify you at your designated email address when documents are available for viewing. If you elect to receive documents via EDD, you may not opt out of receiving notifications when electronic documents become available.  Should your email address become invalid or email undeliverable, delivery of the selected documents will automatically return to the standard USPS mail delivery format
  • You acknowledge and agree that certain minimum hardware and software are needed to make electronic transactions, listed below. You represent that you have the necessary computer hardware and software to view, download and print any documents you have elected to receive electronically.
    • To view your documents, or download or print them for future reference, you will need a browser listed in the Supported Browsers section below, as well as a printer with graphics capabilities.
    • Some documents, such as EOB's and EOC's may be available online only in PDF ("Portable Document Format"). To view a PDF, you'll need Adobe Acrobat® Reader which your browser may already provide or which you may download free from Adobe's site at www.adobe.com. If you need technical assistance, you may Contact Us. Downloading may be slow depending on your Internet connection. You may want to test your connection to our site and your viewing, downloading, or printing experience before agreeing to electronic delivery.

Depending on your specific plan, some exceptions to EDD may apply. For example, as noted above, Medicare members who elect to receive documents via EDD may not opt out of receiving notifications when electronic documents become available.  Members will also continue to receive hard copies of any material that are currently unavailable in electronic form and/or if for any reason the EDD is unavailable for certain Health Net plans.

The time it takes to process your change from U.S. mail delivery to electronic document delivery varies depending on the documents you select, as does the amount of time the document is available on the site.  A list of common documents that may be provided via Electronic Document Delivery is below.


For Members:


  • Explanation of Benefits (EOBs). When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your EOB documents become available, notifications will be sent to your email address informing you that the EOB is available for viewing on the healthnet.com website (after logging into your account).  EOBs will remain on the www.healthnet.com website for up to 7 years.  You may opt out of receiving such email notifications when new EOBs are available, even if you elect to receive only electronic EOBs, by changing your Delivery Preferences in your profile on the healthnet.com website.  Not available to all members.
  • Coverage Documents (Evidence of Coverage ("EOC"), Certificates of Insurance, Student Handbooks, Summary of Benefits and Coverage, etc.). In AZ, you can elect to receive these documents electronically. When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your EOC documents become available, notifications will be sent to your email address (unless you have elected not to receive notifications) and they will remain on our site for up to 7 years.  Not available to all members.
  • Billing Statements. For Individual and Family Plan ("IFP") members, you can elect to receive billing statements electronically through the healthnet.com website instead of receiving such statements via postal mail.  When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your billing statements become available, notifications will be sent to your email address (unless you have elected not to receive such notifications) and they will remain on our site for up to 7 years. Not available to all members.
  • Medicare Annual Notice of Change Materials (ANOCs). When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your ANOC documents become available, notifications will be sent to your email address and they will remain on our site for up to 7 years.
  • Medicare Post Enrollment Materials. When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your Post Enrollment documents become available, notifications will be sent to your email address  and they will remain on our site for up to 7 years.
  • All Future Available Online Documents. When you select this option, we will automatically set your delivery preference to online and notify you via email as new document types become available for electronic document delivery (unless you have elected not to receive such notifications).
  • Please note: Not all document types listed above may apply to your respective plan.

For Brokers:


  • Commission Statements. When you select these documents, we will reflect the change to electronic delivery within 48 hours on average, although it could take longer for U.S. mail deliveries already in progress to stop. As your commission statements become available, notifications will be sent to your email address (unless you have elected not to receive such notifications) and they will remain on our site for up to 7 years.

For Employers:


  • Coverage Documents (Evidence of Coverage, Certificates of Insurance, Student Handbooks, Summary of Benefits and Coverage, etc.). In CA, your member's coverage documents will be defaulted to online delivery. Members will be notified via a mailed letter when their coverage documents are available online. If you prefer to have us mail coverage documents to your members, please speak with your account representative.
  • General Service Agreements (GSAs). In CA, your GSA will be available online. If you wish to have a hard copy mailed to you, please contact your account representative.

SUPPORTED BROWSERS

Our officially supported list of browsers is as follows:

  • Internet Explorer 8 and above
  • Firefox 15 and above
  • Google Chrome 22 and above
  • Safari 6 and above

Health Net makes every effort to ensure that our web site functions properly on the aforementioned browsers. All updates are tested on these browsers as well as more recent versions that are implied, but not listed, above (such as Google Chrome 40 and Internet Explorer 11). If we discover any way in which the site does not work properly on a supported browser, a high priority "fix it ticket" is created, and our web team begins work on resolving the issue immediately.

Thank you for taking the time to review this Agreement. We look forward to providing services to you.

Effective: 3/31/2015
Last Updated: 3/31/2015

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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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Schedule of Benefits Disclaimer

This Schedule of Benefits is a brief list of benefits, with applicable copayments, coinsurance and deductibles information for your health plan. It does not list the exclusions and limitations or other important terms applicable to your plan.

For more information, please review carefully the disclosure form for your plan. It includes additional terms and information on certain exclusions and limitations.

The Evidence of Coverage (EOC) for your plan contains the complete terms and conditions of your Health Net coverage. It is important for you to thoroughly review the disclosure form and EOC for your plan, especially those sections that apply to those with special health care needs. You may view your Evidence of Coverage by: closing the current window and clicking on MY MEDICAL BENEFITS.

You may request copies of the forms referenced above for your health plan by: closing this window and clicking on Contact Us at the top of any web page.
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