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Health Insurance Plans For Large Groups

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Health Net HMO Plans For Large Groups

Showing plans for 91367, LOS ANGELES, CA Click here to change

We know how important every decision is when it comes to your businesses. You want an insurance plan that not only exceeds your health care expectations, but also fits your company's budget. At Health Net, we strive to provide options and make your interests our priority. Enroll your business in one of our group plans and let us take care of the rest!


Check out our options below to get started.

Health Maintenance Organization

With Health Maintenance Organization (HMO) plans, members choose a primary care physician (PCP) from our network of providers and pay a fixed monthly fee. Their PCP will then oversee all health care related services, including referrals and authorizations. HMOs are ideal for employees who would like one doctor to coordinate all their medical care at predictable costs.

If you select an HMO plan, your employees can depend on basic, inpatient, and emergency services. Many plans include office visits, hospitalization, X-ray and lab services, prenatal and postnatal services, mental health services and more. Copays may vary according to plan.

Highlights

  • Basic, inpatient and emergency services
  • Preventive care
  • X-Ray and Lab Procedures
  • Prenatal, postnatal and newborn care office visits
  • Mental health services
Full Network HMO plans

Health Net HMO Plans

We know HMOs! Health Net has a variety of plan designs for businesses of all sizes. Our Full Network HMO gives you and your employees access to thousands of physicians and pharmacies across the state.

If you select an HMO plan, your employees can depend on basic, inpatient, and emergency services. Many plans include office visits, hospitalization, X-ray and lab services, prenatal and postnatal services, mental health services and more. Copays vary according to plan.

Elect Open Access (EOA) Plans

Elect Open Access (EOA) is an HMO plan with set copays, unlimited lifetime benefits, and a primary doctor to coordinate all of your care. However, an EOA also offers the flexibility of seeing any provider within Health Net's PPO provider network without needing a referral. For this added convenience, members who visit a PPO provider will have slightly higher copays per visit.

EOA products are also available with our ExcelCare Network, a subset of our full HMO network (see Tailored Network HMO plans below), available in Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Francisco, Santa Clara, Stanislaus and Ventura counties. For more information on EOA plans, call your broker or Health Net representative.

Point-of-Service (POS) Plans

A POS plan combines aspects from both HMO and PPO plans, offering more freedom than a traditional HMO. Members choose a primary care physician from our network of providers, but our POS also offers limited coverage for members who choose to see an out-of-network provider.

Health Net POS is a two-tiered point-of-service plan. Members have the option to use benefits at an HMO benefit level or PPO benefit level whenever they need care. HMO benefits include primary care physician, referral to see a specialist, predictable payments and no claim paperwork. PPO benefits include the option to see any doctor or specialist in the Health Net network without a referral, payment of deductible and coinsurance and possibly filing claim forms.

CONTACT A REPRESENTATIVE TO GET A QUOTE
Tailored Network HMO plans

SmartCare

SmartCare offers a streamlined collection of HMO options to give you meaningful plan choices that are easy to understand, compare and select.

Health Net SmartCare puts together all the pieces you and your employees value, so you can offer them a single solution that works today and tomorrow. Now you and your employees can prosper with:

  • Simple, more flexible plan choices that meet budgets and exceed expectations.
  • A popular and proven network expanded for greater access and value.
  • Whole person health - benefits that make employees feel valued, support their well-being and sustain productivity.

Learn more about SmartCare

ExcelCare Network

Health Net's ExcelCare Network combines all the best benefits from our HMO and Elect Open Access (EOA) plan with a select network of affordable providers. The ExcelCare Network was designed to be a cost-effective health plan that offers quality coverage.

Learn more about ExcelCare Network plans

PremierCare

This affordable HMO subset plan gives your group members access to Sutter Health's large provider network. Available in select California counties.

Learn more about PremierCare Network plans

Salud con Health Net

Salud con Health Net is a system of health care designed to specifically address the cultural preferences of the Hispanic community. Members enjoy a health care experience that's affordable, local and culturally competent.

Salud plans make it possible to get what's really important when it comes to benefits - comprehensive coverage, plan choice and low, predictable copays. Plan members and insureds also have access to participating SIMNSA1 providers in Mexico.

Learn more about Salud plans

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Important Notice

General Purpose
Health Net's National 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 government 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 suppply 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 elibible, 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 conflicats 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, new or revised policies require prior notice or posting on the website 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, new or revised policies require prior notice or website posting 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.
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. Coverage decisions are the result of the terms and conditions of the Member's benefit contract. The Policies do not replace or amend the Member's contract. If there is a discrepancy between the Policies and the Member's contract, the Member's contract shall govern.

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 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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CA
91367

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Here is the contact information for:

91367, LOS ANGELES
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Medi-Cal: 1-800-327-0502

CalViva: 1-888-893-1569

Dental: 1-800-213-6991

TTY/TTD: 711

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