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.
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.
