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Decision Support

Decision Power®Health & Wellness

The following Decision Power Health & Wellness features are available to Health Net members at no additional cost:

  • Talk to a Clinician - a licensed nurse offers reliable guidance any time day or night, via phone or chat. You can reach out with any health concern, from how best to manage a chronic condition to how to treat a minor injury. Our nurses are trained to ask the right questions to help you get the care you need and the help to better manage your health.
  • Quit for Life® stop tobacco program - telephonic 1:1 support, with web-based resources and chat help every step of the way. A comprehensive Quit Guide will help you through your quit process.
  • Decision Power Healthy Discounts - save with discounts on weight loss solutions with Jenny Craig®; and Weight Watchers®, and on other health and wellness products and services.
  • Care Alerts - Individual reminders based on care gaps, preventative screenings, immunizations and medication safety all help reduce risk and promote self-care.

Decision Power Healthy Discounts

At Health Net, we believe good health is more than the absence of illness. It's about staying active, having a good attitude and feeling comfortable. We recognize that healthy living goes beyond your covered medical benefits. And with this in mind, we have developed a program called Decision Power Healthy Discounts. This discount program rewards you for being a member - and it's available to Health Net members.*

The products and services described below are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to Health Net's grievance process.

Services include:

  • Acupuncture
  • Children's Health Products and Services
  • Chiropractic
  • Emergency Medical Information Service
  • Eye Exams, Glasses, Contacts and LASIK
  • Fitness Clubs
  • Fitness Equipment and Apparel
  • Healthy Living Books, Magazines and Videos
  • Hearing Aids and Screenings
  • ChooseHealthy Store
  • Pregnancy and Childbirth
  • Programs for Members with Medicare
  • Massage Therapy
  • Vitamins, Herbs and Supplements
  • Weight Management
  • Program terms and conditions

Membership in Decision Power Healthy Discounts is automatic and free. So take a moment today to find out more about Decision Power Healthy Discounts. Soon, you could be enjoying the advantage of Health Net membership and the rewards of living well.

If you would like more information regarding Decision Power Healthy Discounts, Contact Us for more information.

For our Health Net Cal MediConnect members and the community,
You can also get the following health education programs and services at no cost to you:

Health Education Programs

HEALTH EDUCATION CLASSES

Attend classes on nutrition, heart health, diabetes, and more to help you stay healthy. Classes are offered at Health Net's Community Resource Center and partner agencies.

HEALTHY HABITS FOR HEALTHY PEOPLE PROGRAM

Learn how to eat healthy and stay active. Get nutrition tips, a DVD, and exercise band to help you meet your goals.

HEALTHY HEARTS, HEALTHY LIVES PROGRAM

Learn how to have a healthy heart. Call the number below to get a guide, tracking journal and DVD to stay healthy.

MATERIALS

Get information on weight control, heart health, immunizations and health exams, and more.

View some of Health Net's health education materials.

Download the Wellness and Health Promotion Programs and Services flyer – English (PDF)
Download the Wellness and Health Promotion Programs and Services flyer – Spanish (PDF)

Download the High Blood Pressure, What You Need to Know flyer – English (PDF)
Download the High Blood Pressure, What You Need to Know flyer – Spanish (PDF)

Download the Steps To Prevent Falls flyer – English (PDF)
Download the Steps To Prevent Falls flyer – Spanish (PDF)

Download the Oral Health and Dentures flyer – English (PDF)
Download the Oral Health and Dentures flyer – Spanish (PDF)

Download the Alzheimer's and Brain Health flyer – English (PDF)
Download the Alzheimer's and Brain Health flyer – Spanish (PDF)

To order materials or attend a class, call the Health Education Information Line at 1‑800‑804‑6074 (TTY: 711), 8:00 a.m. to 5:00 p.m. Monday through Friday, excluding holidays and company closure days between Christmas and New Year.

Disclaimer

Health Net Decision Power Healthy Discounts is not intended as a benefit program purchased from Health Net. The Decision Power Healthy Discounts program is made available to specified Health Net members free of charge. Decision Power Healthy Discounts programs offer discounts on products/reduced-fee services. However, the products and services available from Decision Power Healthy Discounts are not part of your medical benefits plan, but are part of Health Net's Wellness Program available to its members. Decision Power Healthy Discounts providers are independent businesses. Health Net does not directly contract with providers. Services and/or supplies must be purchased directly from a Decision Power Healthy Discounts provider.

Information last updated 09-01-2015

Do you have feedback about a Cal MediConnect plan?

Contact Health Net's Customer Service       You may also communicate your concern to Cal MediConnect

Health Net Community Solutions, Inc. is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

H3237_2018_0036_MP CMS Approval pending

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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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How do I add or delete family members (ex. newborns,adoptions)?

You may add or delete family members during your open enrollment period. In addition, we will generally accept enrollments for newly eligible members within 30 days after the following events (with proper documentation submitted to us):



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This enrollee's premiums are more than 1 month past due. Coverage is currently suspended due to non-payment of premiums. Outstanding authorizations for service are no longer valid. There is no further coverage for any services rendered unless premiums are paid in full by the end of a 3 month grace period. Please contact us for more information.

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New Year, New Website for You!


Your Health Net Coverage for 2018 comes complete with a brand-new website. The design and menus are easier to navigate. And it's packed with helpful information about your plan, your network and all the extras that come with your coverage.