For 2019 Health Net is not making any drastic changes to their portfolio of plans offered to California individuals and families in 2019. One new plan is a High Deductible Health Plan that is Health Savings Account compatible. All the Health Net plans offered through Covered California will be mirrored off-exchange or directly from Health Net. The Health Net PPO plans with the larger provider network will only be available directly from Health Net.
Variety Of Health Net Plans For 2019 In California
Health Net offers a variety of different plan types: EnhancedCare PPO, PureCare One EPO, PureCare HSP, CommunityCare HMO, and their straight PPO plan. The region where you live will determine which plans Health Net will offer. Some regions will have more than one plan type. For example, Orange County will have the EnhancedCare PPO and CommunityCare HMO plans to select from. The available options expand when you enroll direct with Health Net with the addition of their PPO plans in some regions.
- CommunityCare plans are your typical HMO type of health insurance. You need a primary care physician who will in most situations be the person who makes a referral to a specialist.
- HSP or Health Service Plan is modified version of an EPO plan offered only in Bronze and Minimum Coverage plans. HSP plans are paired with the HMO plans to offer a full metal tier range of products. You can make an appointment with any doctor in the network. There is no out of network coverage.
- EnhancedCare PPO allows the member to make an appointment with any doctor in the network. The network is a smaller version of Health Net’s full IFP network offered through their standard PPO plans.
- PureCare One is Health Net’s exclusive provider organization (EPO). Plan members can visit any provider in-network, but there is no out-of-network coverage, similar to an HMO. You can make an appointment with any doctor in the network. There is no out of network coverage.
Health Net has added a High Deductible Health Plan (HDHP) that is H.S.A. compliant to its EnhancedCare PPO plan family. It will have a standard HDHP benefit design with a $6,000 individual deductible and $6,650 maximum out-of-pocket amount. The member pays the full negotiated rate for services out of their Health Savings Account until they have met the deductible. Then they go into 40% coinsurance until they meet the maximum out-of-pocket amount.
Health Net’s EnhancedCare PPO and their full network PPO do have out-of-network coverage, but avoid it if you can. First, you will have to meet an out-of-network (OON) deductible before you go into cost sharing. Once the OON deductible is met, the plan will pay 50% of the maximum allowable amount for the health care service, determined by Health Net, which may be less than what the provider charges. In addition, you need to get prior authorization for out-of-network service (excluding emergency care). Otherwise there may be additional fees from Health Net without prior authorization.
The out-of-network deductible for an individual is $12,600 for Bronze, $12,000 for Bronze HDHP, $9,000 for Silver Value, and $5,000 for all the other plans. The maximum out-of-pocket, at which point the plan will cover 100% of the maximum allowable amount, is $25,000 for each plan, Bronze through Platinum, for a single individual. Carefully read the Evidence of Coverage for your selected plan for more details on the out-of-network coverage.
Value Silver And Gold Plans
For consumers enrolling direct with Health Net, in certain regions the full network PPO will be available along with the EnhancedCare PPO that includes the Silver Value and Gold Value plans. The Silver Value has a $4,500 individual deductible which is higher than the standard Silver 70 plan. However, it has a lower maximum out-of-pocket amount of $7,000. It also has many health care services at a set copayment and prescription drug coverage.
The Gold Value EnhancedCare PPO has a $1,000 individual deductible and $6,000 maximum out-of-pocket amount. It also has set copayments for many routine health care services and prescription drug coverage. The Value plans typically have a lower premium rate attached to them.
Dental And Vision Option
All of the plans include pediatric dental and vision benefits for dependents through 18 years of age. Health Net is making it easier to add adult dental and vision to their off-exchange plans. They call the added dental and vision benefits the Plus package. For the EnhancedCare PPO, PureCare EPO, and PPO plans the Plus package of dental and vision benefits is $14.42 per adult. The maximum dental benefit per year is $1,000. Instead of a member cost-sharing percentage these plans have a fee schedule. For example, a filling on one tooth would be $22. It’s best to use a network dentist so there will not be any balance billing over the set fee. The vision benefits are a little on the light side with the frame allowance of only $85. But vision coverage is accepted by many major chain retailers. See the summary of benefits in the document section below.
The vision and dental package for Health Net’s HMO and HSP plans is $7.62 per adult. The dental plans are HMOs where you must designate a dentist from their network. There is no deductible or annual maximum benefit amount, but many dental services will have a set copayment amount, excluding many preventive services. The vision plan with the HMO and HSP plans will have set copayments for exams and materials. Specialty options for the lenses will have discounts.
Health Net has prepared separate Evidence of Coverage documents for those plans where the member adds the Plus package of vision and dental benefits. Are these plans the best dental and vision options? Not necessarily. Like health care, the best plans are the one that has your dentist or optometrist in-network. However, people have often complained that a health plan should include dental and vision benefits because most people use those services more than a primary care physician. The Health Net rates are attractive compared to other standalone dental and vision plans, which can easily reach $70 per person per month.
Other Changes For 2019
The HSP bronze plans will go away in Northern California for 2019, but remain in Southern California. The alternative is the EPO plans. There will be no auto-migration, so consumers in these plans must proactively select a new plan in 2019.
The full network PPO plans off-exchange, direct from Health Net, will continue to have Stanford and Sutter health care provider’s in-network for 2019. But always confirm your physicians and other providers are in-network for the new plan year. The EnhancedCare PPO will no longer include Walgreen’s pharmacy. The PPO pediatric dental benefits will no longer have any out-of-network coverage.
Health Net’s online systems have undergone major changes in the last year. It is best to check your online account, or create one if you don’t have one, and make sure everything is correct and up to date including automatic online premium billing and payments.
Health Net IFP Documents
Some documents are still being added prior to open enrollment.
- Covered CA
- Dental and Vision
- Doctor House Call Program Health Net
- Drug Formulary Essential Subject To Change Health Net
- EnhancedCare PPO Overview Health Net 2019
- HIPAA Disclosure Form Authorized Rep
- Medical Insurance Glossary of Terms
- Plan CoverdCA Overview Health Net 2019
- Plans Benefit Cost Chart Health Net 2019
- Plans by Region Health Net 2019
- Plans Direct Overview Health Net 2019
- PureCareOne Overview Health Net 2019
- Rates Health Net California 2019
- Self Refer HSP EPO Plans Health Net 2019