Health Net cancels PPO plans for ACA tax credits and adds new HMO like product in Southern California.
Health Net of California is sending letters to current members in their IFP PPO plans that they can keep the health plan they purchased through Covered California but they won’t be able to receive the ACA tax credits in 2015. Health Net will no longer offer their PPO plans through Covered California. In their place will be Exclusive Provider Organizations or Healthcare Service Plans. The PPO plans will only be offered off-exchange and are not eligible for tax credits.
Multiple Health Net plan changes in California
Health Net is making some dramatic changes to their health plan offerings for individuals and families in California. We already knew they were dropping their PPO plans, but the letters being sent to current Health Net members details the extent of the changes.
Covered California PPOs cancelled
Health Net will no longer offer a Preferred Provider Organization (PPO) health plan of any metal tier through Covered California. If current members wish to keep their 2014 PPO plan they must apply directly through Health Net to purchase it in 2015. There are no tax subsidies for the PPO plans purchased directly from Health Net during the open enrollment period starting November 15, 2014.
Consumers rolled into new EPO and HSP plans
Consumers who purchased a Health Net PPO plan through Covered California and do not make a selection to a different health plan during open enrollment, November 15th – December 15th for January 1st 2015 effective date, will be enrolled in the new Health Net EPO or HSP plans. However!
Health Net drops Monterey, Mariposa, San Benito
Health Net will no longer offer any health plans through Covered California for the counties of Monterey, Mariposa and San Benito. Residents in these counties who receive tax credits will have to enroll with a different carrier.
PPO plans with no tax credits still offered
Residents in Monterey, Mariposa and San Benito can enroll directly with Health Net for their current PPO plan off-exchange but will receive no tax credits to reduce their premiums.
Health Service Plans come to Southern California
PPO plans in Southern California are being converted to a Healthcare Service Plan (HSP). HSPs require the members to select a Primary Care Physician and there is no out-of-network coverage. They more closely resemble a Health Maintenance Organization (HMO) than they do the EPO that Covered California indicated would be offered by Health Net in their 2015 health plans booklet. From the text of the letters to members who may have the HSP choice Health Net states-
You also have to pick a primary care physician (PCP)- a main doctor to see for checkups, advice and care when sick or hurt. However, you can go directly to any doctor or specialist in the network. – Health Net member letter
An HMO called an HSC?
From the verbiage it sounds like a member can self-refer to a specialist that is in the network which somewhat contradicts that statement that you need to see the chosen PCP. The details, conditions and restrictions will be spelled out in the Evidence of Coverage document that I hope will be available before open enrollment so we can really read how this new plan will work. Their correspondence says they have not received approval for this new plan they expect to offer so they can’t give any details about the new HSP plans.
Tailored networks sound so form fitting
From an agent update regarding the changes to the health plans it looks as if the provider networks for the new EPO and HSP plans will be smaller than the original PPO plans. But instead of using a term like narrow network or tiered network, Health Net has chosen the adjective “tailored” network-based plans. Tailored means they cut providers like a tailor cuts excess material out of a suit jacket or slacks. Consumers need to be hyper vigilant in confirming their existing physicians, labs, pharmacies and hospitals will be supported by either the new EPO or HSP tailored network-based plans. It’s highly probable that your Health Net doctor today might not be in-network tomorrow if you roll into one of the new plans.
Less benefits, more money
Not only will Health Net members get reduced benefits and fewer providers with the new EPO and HSP plans, they are also being asked to absorb a price increase of 6% to 9% depending on the plan and region. (See: 2015 plan rate comparison by region)On a positive note, Health Net is trying to provide lots of information in the form of letters to members that spell out the different options. Their communication is better than what Covered California has released with respect to the new plans and different options. However, these cancellation notifications are probably the first that Covered California has heard about the new Health Net HSP switcheroo for Southern California.
See also: Health Net Drops PPO plans from Covered California
Health Net 90 Day cancellation notification alert
California Brokers: New California Individual & Family Plan Portfolio for 2015
90-Day Member Plan Closure Notices Mail October 2, 2014
Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) are making some significant changes to our California Individual & Family Plan portfolio for 2015. The changes are designed to meet consumer demand for affordability and choice.
For 2015, we will offer:
Two new tailored network plans.
Our most affordable plans are the ones we pair with tailored networks, which is why we have designed two new ones.
We are awaiting regulatory approval for an Exclusive Provider Organization (EPO) plan in Central and Northern California, and a Health care Service Plan (HSP) in Southern California. Until then, we do not have any plan information to release.
Upon approval, we will offer these plans on- and off-exchange except in Mariposa, Monterey and San Benito counties. These three counties will no longer have Health Net plan options available through Covered California™.
Our current PPO plans will be offered off-exchange only in the same rating regions as 2014.
Your on-exchange clients can keep their Health Net PPO coverage if they work with you to re-apply directly through Health Net. This is the only choice for members in Mariposa, Monterey and San Benito counties who want to have Health Net coverage.
Please note, consumers have to buy health coverage through Covered California to get tax credits. Buying direct versus through Covered California makes members ineligible for tax credits.
CommunityCare HMO plans in Southern California. We will continue to offer these popular HMO plans in platinum, gold and silver metal levels both via Covered California and direct from Health Net.
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