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- HMO
- HSP
2017 HealthNet Plans CoveredCA IFP (2.6 MiB)
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.
2016 Health Net individual and family
Health Net has a complicated matrix of various plans offered in different regions across California for on and off exchange enrollment. In addition, they closed PPO plans for 2016 in many central coast and southern California regions.
- Disclosures
- Covered California Plans
EPO CC 2016 CC Disclosure (2.7 MiB)
HMO HSP CC 2016 Disclosure (3.3 MiB)
- Off Exchange
EPO 2016 Disclosure (2.6 MiB)
PPO 2016 Disclosure (160 KiB)
- EPO_Plans
Bronze EPO 2016 Overview (25 KiB)
Gold EPO 2016 Overview (23 KiB)
Platinum EPO 2016 Overview (25 KiB)
Silver 70 EPO 2016 Overview (25 KiB)
- HMO_Plans
Gold HMO 2016 Overview (158 KiB)
Platinum HMO 2016 Overview (160 KiB)
Silver 70 HMO 2016 Overview (31 KiB)
- HSP_Plans
Bronze HSP 2016 Overview (31 KiB)
Gold HSP 2016 Overview (28 KiB)
Min Coverage HSP 2016 Overview (31 KiB)
Platinum HSP 2016 Overview (30 KiB)
Silver 70 HSP 2016 Overview (31 KiB)
- PPO_Plans
Bronze PPO 2016 Ca Overview (26 KiB)
CA Proof Permanent Residency (43 KiB)
Gold PPO 2016 Overview (23 KiB)
Min Coverage PPO 2016 Overview (25 KiB)
Platinum PPO 2016 Overview (25 KiB)
Silver 70 PPO 2016 Overview (25 KiB)
2016 Health Net CA IFP Plan List (274 KiB)
CA IFP EPO Application 2016 (3.0 MiB)
CA IFP HMO Application 2016 (452 KiB)
CA IFP HSP Application 2016 (3.0 MiB)
CA IFP PPO Application 2016 (3.0 MiB)- CA Proof Permanent Residency (43 KiB)
Health Net 2016 Premium Rates by Age and Region (1.6 MiB)
HN-Well-myStrength-flyer (408 KiB)
Prior Authorization List 2016 Health Net (76 KiB)
2016 Health Net Plan type by Region
From Health net 2016 review dated September 28, 2015
Plans available through Covered California View: California Region Plan Map
| Covered California Plans | Regions |
| Platinum 90 HMO | 14-19 |
| Gold 80 HMO | |
| Silver 70 HMO | |
| Silver 94 HMO | |
| Silver 87 HMO | |
| Silver 73 HMO | |
| Platinum 90 HSP | 1, 3, 7, 11 |
| Gold 80 HSP | |
| Silver 70 HSP | |
| Silver 94 HSP | |
| Silver 87 HSP | |
| Silver 73 HSP | |
| Bronze 60 HSP | 1, 3, 7, 11, 14-19 |
| Minimum Coverage HSP | |
| Platinum 90 EPO | 2, 4, 5, 8-10 |
| Gold 80 EPO | |
| Silver 70 EPO | |
| Silver 94 EPO | |
| Silver 87 EPO | |
| Silver 73 EPO | |
| Bronze 60 EPO | |
| Minimum Coverage EPO |
Plans available direct through Health Net
| Off-Exchange Plans* | Regions |
| Platinum 90 HMO | 14-19 |
| Gold 80 HMO | |
| Silver 70 HMO | |
| Platinum 90 HSP | 1, 3, 7, 11, 14-19 |
| Gold 80 HSP | |
| Silver 70 HSP | |
| Bronze 70 HSP | |
| Minimum Coverage HSP | |
| Platinum 90 EPO | 2, 4, 5, 7-10, 14, 15, 17-19 |
| Gold 80 EPO | |
| Silver 70 EPO | |
| Bronze 60 EPO | |
| Minimum Coverage EPO | |
| Silver 70 PPO | |
| Bronze 60 PPO | |
| Minimum Coverage PPO |
*Health Net quoting engine shows PPO Gold and Platinum plans also being offered in many regions. Always call Health Net to confirm.
Disclosures and Outline of Coverage
Health Net encapsulates all the different metal tiers they offer within a plan type (EPO, HMO, PPO, etc.) in one Disclosures and Outline of Coverage documents. There are two plan types offered through Covered California and two offered Off-Exchange directly from Health Net.
Covered California
- EPO CC 2016 CC Disclosure (2.7 MiB)
- HMO HSP CC 2016 Disclosure (3.3 MiB)
Off-Exchange
- EPO 2016 Disclosure (2.6 MiB)
- PPO 2016 Disclosure (160 KiB)
Health Net IFP 2015
Health Net will discontinue offering any PPO plans through Covered California in 2015. In Northern California the PPO plans will be replaced with an EPO. If you would like to keep your PPO plan, you will have to enroll in the PPO off-exchange. There will be no subsidies to reduce the monthly premium. The Off-Exchange menu tab will have a Health Net link to get a quote for the off-exchange EPO, HMO, HSP, and PPO plans. In Southern California the PPO Bronze and Minimum Coverage plans will be replaced with a HSP. See: The differences between EPO, HSP, HMO, PPO.
- HSP: Health Service Plans only be available in Bronze and Minimum Coverage through CoveredCa in Southern California.
- EPO: Exclusive Provider Network will be available in all metal tier levels in Northern California.
- HMO: Health Maintenance Organizations will be offered in the Silver through Platinum tier levels in Southern California.
On-Exchange Covered California
For 2015 Health Net will offer three plan types: Exclusive Provider Organizations (EPO), Health Maintenance Organizations (HMO) and a new Health Service Plan (HSP). All plans On and Off the exchange include pediatric dental and vision administered Dental Benefit Providers of California and Eyemed Vision respectively.
Northern California EPO
The EPO plan replaces the PPO plans in all metal tier levels in Northern California. The EPO will use the PureCare One provider network. A three tier drug formulary will be employed. The major diffence between an EPO and a PPO is that there is no out-of-network coverage. However, the summary of benefits notes out in-network copayments and coinsurance will not apply to out-of-network services.
Southern California Community Care HMO and HSP
The HMO and HSP plans will use the Essntial Rx Drug List. The provider network for the HMO is called Community Care and PureCare for the HSP. HSPs will only be offered for Minimum Essential or Catastrophic plans in Southern California through Covered California. The HSP will be available in Silver through Platinum Off-exchange.
PPO Off-Exchange
Individuals and families can enroll in all of Health Net’s plans Off-Exchange. In Southern California Health Service Plans will be available from Minimum to Platinum. The HMO plans will still only be offered in Silver through Platinum. The PPO plans will only be offered Off-Exchange. EPO plans can also be purchased Off-Exchange. Health Net Off-Exchange plans had a larger network of providers in 2014 than their On-Exchange plans.
Network exclusions
These conditions and exclusions to health plans and networks come from inquiries with Health Net customer service staff. Until Health Net releases their Evidence of Coverage for the 2015, they can’t be completely verified.
- The EPO PureCare One network is separate from the PureCare HSP network. A member of an EPO can’t see a provider in the HSP network as in-network. The same is true of HSP members visiting and EPO network provider.
- EPO and HSP members can see network provider in another region if the provider is within 30 miles of the member’s residence. For example, an HSP member in Northern Los Angeles County (Region 15) can see a provider in Southern Los Angeles County (Region 16) as long as the distance is no greater than 30 miles. Otherwise, the provider will be considered out-of-network. This condition was verbally given to me and another consumer over the phone.
- There will be no roll-over of monies paid toward the deductible or maximum out of pocket amounts (MOOP) between EPO, HSP or PPO plans. In other words, if a family enrolls in a PPO plan in January and then switches to an EPO plan in March, any health care dollars they paid toward meeting their deductible or MOOP will not be attributed to the new plan. A new plan resets the deductible and MOOP. Again, this information was from a Health Net customer service representative.
Health Net plans by County and Region
| Covered California | & Off-Exchange | Off-Exchange Only | ||
| EPO Counties | Region | PPO Counties | Regions | |
| Contra Costa | 5 | Contra Costa | 5 | |
| Kern | 14 | Kern | 14 | |
| Marin | 2 | Los Angeles | 15, 16 | |
| Merced | 10 | Marin | 2 | |
| Napa | 2 | Mariposa | 10 | |
| San Francisco | 4 | Merced | 10 | |
| San Joaquin | 10 | Monterey | 9 | |
| San Mateo | 8 | Napa | 2 | |
| Santa Clara | 7 | Orange | 18 | |
| Santa Cruz | 9 | Riverside* | 17 | |
| Solano | 2 | San Benito | 9 | |
| Sonoma | 2 | San Bernardino* | 17 | |
| Stanislaus | 10 | San Diego | 19 | |
| Tulare | 10 | San Francisco | 4 | |
| San Joaquin | 10 | |||
| HMO, HSP Counties | Region | San Mateo | 8 | |
| Los Angeles | 15, 16 | Santa Clara | 7 | |
| Orange | 18 | Santa Cruz | 9 | |
| San Diego | 19 | Solano | 2 | |
| Riverside* | 17 | Sonoma | 2 | |
| San Bernardino* | 17 | Stanislaus | 10 | |
| *Only partial county served. | Tulare | 10 |
All plans offered through Covered California can be purchased Off-exchange with no tax subsidies. In addition, the Health Service Plans are available Off-exchange in Silver – Platinum tiers.
Health Net Overview Material
The following documents are overviews of the benefits and coverage of each of the plan types. There is also information on the children’s dental and vision coverage along with rates for Off-exchange plans.
Covered California plans
CC EPO Bronze 60 Overview 2015 (140 KiB)
CC EPO Gold 80 Overview 2015 (140 KiB)
CC EPO Minimum Overview 2015 (140 KiB)
CC EPO Platinuim 90 Overview 2015 (142 KiB)
CC EPO Silver 70 Overview 2015 (140 KiB)
CC EPO Silver 73 Csr Overview 2015 (146 KiB)
CC EPO Silver 87 Csr Overview 2015 (146 KiB)
CC EPO Silver 94 Csr Overview 2015 (148 KiB)
HMO Gold 80 Overview 2015 (148 KiB)
HMO Platinum 90 Overview 2015 (150 KiB)
HMO Silver 70 Overview 2015 (153 KiB)
HMO Silver 73 Overview 2015 (151 KiB)
HMO Silver 87 CSR Overview 2015 (153 KiB)
HMO Silver 94 CSR Overview 2015 (151 KiB)
HSP Bronze 60 Overview 2015 (152 KiB)
HSP Minimum Overview 2015 (153 KiB)
Off-Exchange Plans
EPO Bronze 60 Overview 2015 (157 KiB)
EPO Exchange Disclosure 2015 (2.7 MiB)
EPO Gold 80 Overview 2015 (156 KiB)
EPO Minimum Overview 2015 (156 KiB)
EPO Platinuim 90 Overview 2015 (158 KiB)
EPO Silver 70 Overview 2015 (157 KiB)
HMO & HSP Disclosure 2015 (2.9 MiB)
HMO Gold 80 Overview 2015 (1.1 MiB)
HMO Platinum 90 Overview 2015 (1.1 MiB)
HMO Silver 70 Overview 2015 (657 KiB)
HSP Bronze 60 Overview 2015 (655 KiB)
HSP Gold 80 Overview 2015 (161 KiB)
HSP Minimum Overview 2015 (653 KiB)
HSP Platinum 90 Overview 2015 (163 KiB)
HSP Silver 70 Overview 2015 (168 KiB)
PPO Bronze 60 Overview 2015 (1.0 MiB)
PPO Gold 80 Overview 2015 (1.0 MiB)
PPO Minimum Overview 2015 (1.0 MiB)
PPO Platinum 90 Overview 2015 (1.0 MiB)
PPO Silver 70 Overview 2015 (1.0 MiB)
Children’s Dental and Vision Coverage
There are separate plans whether the base plan type is a HSP/HMO or an EPO/PPO product
Off-exchange rates
Norcal Rate Guide 2015 (2.3 MiB)
SoCal Rate Guide 2015 (3.0 MiB)
Health Net 2014
Health Net will not be offering individual and family plans to a large swaths of northern, eastern, southern, or central coast counties in California in 2014. They will be offering PPO plans in the Central Valley and San Francisco Bay areas. In Southern California they will be offering both PPO and HMO plans. California is broken into 19 different pricing and plan regions. Some regions encompass multiple counties and others are just one county.
Health Net Community Care HMO plans
Health Net will only offer their “Community Care” HMO plans in L.A., Orange, Riverside, San Bernardino and San Diego counties either through Covered California or “Off Marketplace”. They will not have a Bronze HMO, only Silver, Gold and Platinum. Health Net PPO Silver, Gold and Platinum plans will not be available in the counties of L.A., Orange, Riverside, San Bernardino or San Diego, but they will be offered outside of the exchange in those counties.
Children’s Dental
Initially, Health Net was to offer the children’s or pediatric dental coverage bundled with all their plans through Covered California. Changes within Covered California have forced them to drop the bundled pediatric dental from the exchange plans. Families that select a Health Net health plan will have to purchase a stand alone pediatric dental plan for children 18 and under.
Bundled Pediatric Dental
Health Net will continue to offer the bundled children’s dental coverage in their plans sold outside of the exchange or off-market. The pediatric dental will be a PPO plan and the parents or guardians will be able to find a local dentist through the provider search on the Health Net website. (Hint: from Provider Search select Ancillary Benefits. The dentist search is run through an outside website so look for a link called Optum on the bottom of the page. Clicking the link will take you to the dental provider search system.)
Family Dental and Vision
Families will also be able to purchase an inexpensive dental and vision plan for approximately $16.46 per adult. The dental plan is an HMO which can tend to have a light network of participating dentists but generally has low copayments for services. If the dental and vision plan is chosen, it must be purchased for all the adults on the application.
Summary of Benefits for Health Net HMO plans
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Summary of Benefits for Health Net PPO plans
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Health Net Individual and Family Rates for ACA compliant health plans
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Paper Applications
In November, 2013, California residents will apply for the new ACA plans on-line through my website.
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Preventive Services, ACA pricing, Notice of Change Form
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Evidence of Coverage Documents
There are two types of Evidence of Coverage documents; one set for plans sold through Covered California, on exchange, and those for plans of Off Exchange or purchased directly from Health Net. One of the primary differences is that the on exchange plans do not include Pediatric Dental which was sold separately on Covered California. EX denotes Exchange or Covered California.
Health Net EOC Bronze PPO Off Exchange 2014 (765 KiB)
Health Net EOC Catastrophic PPO Off Exchange 2014 (763 KiB)
Health Net EOC Gold PPO Off Exchange 2014 (764 KiB)
Health Net EOC Platinum PPO Off Exchange 2014 (763 KiB)
Health Net EOC Silver PPO Off Exchange 2014 (766 KiB)
Health Net HMO EOC Gold Off Exchange 2014 (1.0 MiB)
Health Net HMO EOC Platinum Off Exchange 2014 (1.0 MiB)
Health Net HMO EOC Silver Off Exchange 2014 (1.0 MiB)
Health Net PPO EOC Bronze EX 2014 (725 KiB)
Health Net PPO EOC Gold EX 2014 (722 KiB)
Health Net PPO EOC Platinum EX 2014 (722 KiB)
Health Net PPO EOC Silver 73 EX 2014 (724 KiB)
Health Net PPO EOC Silver 87 EX 2014 (724 KiB)
Health Net PPO EOC Silver 94 EX 2014 (722 KiB)
Health Net PPO EOC Silver EX 2014 (724 KiB)
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