Health Net of California

2018 Health Net IFP

Plan Changes and Updates

HMO Plans

Al 2017 HMO IFP plans will be renewed, or migrated to a similar plan, in all regions in 2018. Health Net has added Teledoc, telephone consultations with a doctor, for a $0 copayment to the CommunityCare HMO. The Advanced Choice Pharmacy Network will replace the standard pharmacy network and will NOT include Walgreens.

HSP Plans

Platinum, Gold, and Silver plans will be discontinued in all regions. Bronze and minimum coverage plans will be renewed in Kern, Los Angeles, Riverside, San Bernardino, Orange, and San Diego counties, and will be discontinued in all other regions.

EPO Plans

All 2017 PureCare One EPO plans will be renewed, or migrated to a similar plan, in all regions in 2018. Stanford hospital and physicians will no longer be part of the PureCare One EPO network. Pediatric dental services obtained out-of-network are no longer covered.

PPO Plans

All PPO plans will be renewed in 2018 in all regions where offered. Mental and behavioral health benefits will be administered by MHN.

EnhancedCare PPO

EnhancedCare PPO plans are new for 2018. They have a tailored network that is not as large as the standard off-exchange PPO plans. EnhancedCare PPO will be available both through Covered California and off-exchange directly from Health Net in Los Angeles, Orange, Sacramento, San Diego, and Yolo counties. It will be offered in parts of Placer, Riverside, and San Bernardino counties.

Covered California

Health Net will offer most of their plans through Covered California except their PPO Off-Exchange plans. The EnhancedCare PPO, with a small provider network than the straight PPO plans, will be offered on and off-exchange.

Summary Documents of Health Net Covered California plans: CommunityCare HMO, PureCare EPO and HSP, EnhancedCare PPO

Evidence of Coverage Documents for Covered California Plans

Health Net Off-Exchange Plans

Off-exchange means you are enrolling directly with Health Net and the plans are not eligible for any Premium Tax Credits from Covered California. In addition to the mirrored plans offered through Covered California, Health Net also offers an EnhancedCare Value Gold and Silver plans with higher deductibles and coinsurance to lower the monthly premium. There are also adult dental and vision plans that can be added to the medical coverage. As of late October, not all of the PPO plans documents had been released pending regulatory approval. Below are the rate tables for each plans by region and specific enrollment applications.

Evidence of Coverage Documents for Health Net plans

Hospitals

Spread sheets of Health Net hospitals by plan. These hospital networks were as of October 2017. Always check the Health Net provider tool for latest additions or changes. Health Net PPO plan is only offered off-exchange.

 

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2017 Health Net IFP

Health Net will be offering the same plans in 2017 as they did in 2016. PPO plans will continue to be offered only off-exchange, not through Covered California.

Health Net 2017 Plans by California Regions

All EPO plan members must select a Primary Care Physician or one will be assigned to them in 2017.

Services obtained from a Non-Preferred or Preferred provider outside of California through the First Health Network will no longer be covered. Only out-of-state urgent care and emergency services will be treated as in-network provider cost shares.

EPO vs HSP

Health Net offers both an EPO (Exclusive Provider Organization) and a HSP (Healthcare Service Plan). They are essentially the same type of health plan. The HSP require a member to list a Primary Care Physician like an HMO. For the EPO, the PCP designation was optional until 2017. More important to Health Net is that the HSP products are listed and regulated by the Department of Managed Health Care, while the EPOs are regulated by the California Department of Insurance, according to Health Net.

To view a list of hospital associated with Health Net Plans visit: California Hospitals By Health Plan By Region

Summary of Benefits Covered California Plans

• EPO
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• HMO
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• HSP
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• 2017 HealthNet Plans CoveredCA IFP (2.6 MiB)

• EPO
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• HMO
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• HSP
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• PPO
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Dental and Vision Coverage Pediatric and Adult

Evidence of Coverage Documents

These are a few of the EOC for Health Net 2017. I can only get EOCs in which I have clients enrolled. Health Net does not released all their EOC documents like other insurance companies. CC in file name indicates it is for a Covered California health plan.

• Bronze HSP CC EOC HN 2017 (3.0 MiB)
• Gold HMO CC EOC HN 2017 (2.0 MiB)
• Platinum EPO EOC HN 2017 (1.7 MiB)
• Platinum PPO EOC HN 2017 (2.1 MiB)
• Silver EPO EOC HN 2017 (2.1 MiB)
• Silver PPO EOC HN 2017 (1.7 MiB)

Health Net 2017 Rate Tables by Plan and Region

Applications for Health Net’s 2017 California Plans Off-Exchange

As more Health Net 2017 documents become available, they will be posted here.

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