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Health Net Life Insurance Company

PPO Gold $30/$0

First, find out if you qualify for financial help.

The government is giving finacial help to people who qualify. The less income you make, the less you pay for coverage.
In order to offer you the best plan options, we need to know if you qualify for this financial help.

See if you qualify (Link opens a subsidy calculator in a new window)

Please select one:

Not sure if you qualify?
Call us at 1-877-527-8409.

Plan Description

A Gold-level PPO health insurance plan that is rich in benefits and has no medical deductible. This plan features a $30 copay for PPO office visits and a 20% coinsurance on most in-network benefits.

Is your current doctor included on this plan? Find out with our ProviderSearch tool

Plan Details

Deductible: None
Out-of-Pocket Maximum: $6,350 per member / $12,700 per family
Coinsurance: 20%
Prescription Drug Deductible: None
Prescription drugs: $19/$50/$70 Most FDA approved prescription contraceptive methods will be covered at $0 member cost share. Note, Health Net may impose cost sharing on brand name drugs when a generic version is available.
Self-injectable Drugs: 20%
Maternity care: 20%
Inpatient hospital services: 20%
Outpatient hospital services/ambulatory surgical center services: 20%
Preventive care: Covered in full
Hearing Aids: Not Covered
Pediatric Dental: Calendar Year Deductibles: $60 (applies to all services) Out-of-pocket maximum: Medical Out-of-pocket maximum applies Dental Check up: $0 Dental Basic Services: 50% Dental Major Services: 50%
Pediatric Vision: Eye Exam (deductible waived): 0% Glasses 1 pair per year
Laboratory Services: $30
X-rays: $50
Outpatient imaging and testing services: 20%
Emergency room services: $250 (copay waived if admitted)
Ambulance services: $250
Urgent care services: $60
Rehabilitative and Habilitative Services: $30
DME (Durable Medical Equipment): 20%
Skilled nursing facility services: 20%
Chiropractic services: Not Covered
Acupuncture services: $30
Mental health services: Outpatient: $30 Inpatient: 20%
Office visit: $30
We can help you look at your choices and we can help you sign-up. Call us at 1-877-527-8409.
We're open 8 a.m. - 6 p.m., Monday-Friday (except holidays) from February 16 - November 14.
And open 8 a.m. - 8 p.m. Monday-Friday (except holidays) from November 15 to February 15.

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Referenced plan:
PPO Gold $30/$0

Disclaimer: This plan may not be available in your area; you may not qualify for this plan based on certain criteria.

What is a PPO?

PPO stands for Preferred Provider Organization. With a PPO, you can choose to see any doctor, go to any hospital. There are no referrals required. PPO plans come with a network. You pay less out-of-pocket when you go to a doctor who is in the PPO network. If you to a non-network provider, your copayment or coinsurance will be more.

Questions

Call us at 1-877-527-8409

Health Net is here to help and answer your questions.
We’re open 8 a.m. – 6 p.m., Monday-Friday (except holidays) from February 16 – November 14.
And open 8 a.m. – 8 p.m. Monday-Friday (except holidays) from November 15 to February 15.
This call is free.

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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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Health Net of Arizona, Inc.
CommunityCare HMO


The predictability of our HMO plans with the flexibility to see in-network specialists without a referral for certain professional services. Available for small businesses in Maricopa, Pima and Pinal counties.


HSA-compatible plans offer advantages of coverage with the tax-savings potential of a health savings account. It's one way to take more control over your health care dollars.

Health Net of Arizona, Inc.
HMO Statewide


The predictability of our HMO plans with the flexibility to see in-network specialists without a referral for certain professional services.

Health Net
Life Insurance Company
PPO


Competitively priced, Health Net Life Insurance Company's PPO insurance plans are a perfect fit for groups that want to offer their employees choice and flexibility. Employees can go directly to our broad PPO network of doctors and hospitals. Or they can see a doctor and use covered services outside the network. Out-of-pocket costs are generally lower when using the PPO network.


HSA-compatible plans offer advantages of coverage with the tax-savings potential of a health savings account. It’s one way to take more control over your health care dollars.

PPO

Competitively priced, Health Net Life Insurance Company’s PPO insurance plans are a perfect fit for groups that want to offer their employees choice and flexibility. Employees can go directly to our broad PPO network of doctors and hospitals. Or they can see a doctor and use covered services outside the network. Out-of-pocket costs are generally lower when using the PPO network.

PureCare One EPO

Exclusive Provider Organization (EPO) insurance plans from Health Net Life Insurance Company bring together HMO and PPO elements. Like an HMO, these plans come with a set provider network – the PureCare One EPO network. There is no coverage for services received outside of the network, except for urgent or emergency care, or for services authorized by Health Net. What’s different is that there is no requirement to have a primary care physician. Members may self-refer to any in-network provider.

SmartCare HMO

Health Net of California, Inc.'s SmartCare HMO plans connect members to a tailored network of provider groups and hospitals near where they live or work. Adding convenience, SmartCare includes access to CVS MinuteClinics for walk-in medical services and preventive care. Available in Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Clara and Santa Cruz Counties.

WholeCare HMO

Health Net of California, Inc.’s WholeCare HMO plans come with our largest tailored network – delivering access and affordability for employers and employees alike. Available in 30 counties statewide, WholeCare HMO plans also feature CVS MinuteClinics for walk-in medical services and preventive care.

Salud HMO y Mãs

Health Net of California, Inc.'s Salud HMO y Mãs plans are designed to fit California's fast-growing Latino market offering cost-savings for employers (over comparable HMO plans) and predictable copayments for employees. Members enrolled in these plans use the Salud HMO y Mãs network in California or may self-refer to a participating provider in Health Net's Mexico service area for covered services. Salud HMO y Mãs plans also feature CVS MinuteClinics for walk-in medical services and preventive care.

PureCare HSP

Health Net of California, Inc.'s PureCare HSPs (health care services plan) work much like an HMO in that members are required to have a primary care physician. What’s different is that HSP members have the flexibility to self-refer to doctors and hospitals in the PureCare HSP network. There is no coverage for out-of-network services, except for urgent or emergency care, or services authorized by Health Net.

Full Network

We've brought our popular Full Network HMO back. It pairs with any of our Gold or Platinum HMO plans in nearly all California counties! These Full Network HMO plans come with our 30 county statewide HMO network. Full Network HMO plans also feature CVS MinuteClinics for walk-in medical services and preventive care.

CommunityCare

We're introducing a pair of CommunityCare Silver-level plans for employers in Los Angeles and Orange counties. These HMO designs come with our locally based CommunityCare network and the convenience of CVS MinuteClinics for walk-in medical services and preventive care.

CommunityCare

Health Net Health Plan of Oregon, Inc. (Health Net) CommunityCare plans are available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.


Our base plan, featuring the familiar single-tier benefit structure and access to the select Health Net CommunityCare network, is the most affordable CommunityCare option.

CommunityCare Choice Plus

Health Net Health Plan of Oregon, Inc. (Health Net) CommunityCare Choice Plus plans are available to Oregon groups located in Multnomah, Clackamas, Washington, Clatsop, Columbia, and Tillamook counties.


Choice Plus gives members three levels of access and coverage. They can use the CommunityCare network, other Health Net contracted providers, or a non-network provider. Services received via the CommunityCare network are covered at a higher, in-network benefit while out-of-network services are reimbursed at a percentage of the maximum allowable amount.


Standard Plans

Health Net Health Plan of Oregon, Inc. (Health Net) Standard plans are available to Oregon groups statewide. The benefit design of these plans match those designated by the State of Oregon. Pediatric vision coverage is included. Pediatric dental coverage is not available with these plans.

PPO

Health Net Health Plan of Oregon, Inc. (Health Net) Preferred Provider Organization (PPO) plans are available to Oregon groups statewide. Our PPO plans feature our widest range of deductible options to fit a variety of budgets.

PPO

Health Net Health Plan of Oregon, Inc. (Health Net) Preferred Provider Organization (PPO) plans are available to Washington groups statewide, and are a perfect fit for groups that want to offer their employees choice and flexibility. They have full access to PPO doctors and hospitals in the First Choice network. Or they can see a doctor and use services outside the network for a higher out-of-pocket cost.

Contact Enrollment Services

Enrolling is easy. Contact your regional Health Net representative using the number below
and we'll help you with the rest.


Here is the contact information for:

91367, LOS ANGELES
Click here to change location.

Medi-Cal: 1-800-327-0502

CalViva: 1-888-893-1569

Dental: 1-800-213-6991

TTY/TTD: 711

Contact Enrollment Services

Joining is easy. Call Health Net using the number below and we will help you with the rest.


Here is the contact information for:

91367, LOS ANGELES
Click here to change location.

Dental: 1-800-213-6991

Where You Can Buy Plans

You can buy health coverage directly from Health Net. We are also a part of Covered California® so you can buy a Health Net plan through the marketplace.


You have to buy health coverage through Covered California to get financial help from the government. You can click our link below to see if you qualify. Then Health Net can help you sign-up.

About Plan Years

Health plan choices may change from year-to-year. There may be new plan choices. Or changes in costs and benefits. Choose the year that matches when you want coverage to start. For example, click 2016 if you are looking at choices for next year. Have a special enrollment period for this year? Then click 2015. Note that the first effective date for our 2016 plans is January 1, 2016.

About Plan Levels

Health plans for individuals and families come in four metal levels: platinum, gold, silver and bronze. The difference between the levels is how much you pay versus how much the health insurance company pays.

There is also a minimum coverage option for people under 30. It’s also for people having financial hardship.

Health Net offers plans in all metal levels. So we have an option for you no matter what level of coverage you want.

About Plan Types

We offer several types of plans. There are HMO and HSP plans offered by Health Net of California, Inc. PPO and EPO insurance plans are offered by Health Net Life Insurance Company.

With an HMO, you have one main doctor called a primary care physician who coordinates all your care. You see your PCP for checkups, advice and care when sick or hurt. Your doctor refers you to other services when you need them. You get all services from the HMO network. There is no coverage if you see doctors who are not in the network, except in an emergency.

EPO insurance plans also come with a network of doctors and hospitals. You do not need a referral to use covered services but you do have to use the EPO network. There is no coverage if you see doctors who are not in the network, except in an emergency.

An HSP (Health care service plan) has one network to use for all covered services. There is no coverage for services received outside of the network, except in an emergency or for urgent care. With an HSP, you are required to pick a primary care physician (PCP)– a main doctor to see for checkups, advice and care when sick or hurt. Members can go directly to any doctor or specialist in the network without the need for a referral.

PPO plans give you the choice to go directly to any doctor. You can see a doctor in the PPO provider network. Or you can visit a doctor outside our network. You generally pay less out-of-pocket when you go to a doctor that is in the PPO network.

You have a PCP PCP referral needed before you get services Have one network for all services OK to get services outside of the network
HMO Yes Yes Yes, CommunityCare No, except as noted above.
EPO No No Yes, PureCare One No, except as noted above.
HSP Yes No Yes, PureCare No, except as noted above.
PPO No No No. Using the PPO network is your choice. When you do, you generally pay less out-of-pocket! Yes

About Financial Help

You can buy health coverage directly from Health Net. We are also a part of Covered California® so you can buy a Health Net plan through the marketplace.

You have to buy health coverage through Covered California to get financial help from the government. You can click our link below to see if you qualify. Then Health Net can help you sign-up.

About Pediatric Dental

Special Needs Plan Disclaimer

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