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Health Net Bronze 60 PPO

Health Net Bronze 60 PPO	In-Network	Out-Network
Cost Share Information
Individual Deductible	$6,300	$12,600
Family Deductible	$12,600	$25,200
Out of Pocket Limit-Individual	$6,800 (including deductible)	$25,000 (including deductible)
Out of Pocket Limit-Family	$13,600 (including deductible)	$50,000 (including deductible)
Co-Insurance	100%	50%
Lifetime Maximum	Unlimited	Unlimited
Office Visits
Primary Care	$75 deductible waived for 1st 3 visits	50% after deductible
Specialist	$105 deductible waived for 1st 3 visits	50% after deductible
Adult Preventive Care	No Charge	Not Covered
Child Preventive Care	No Charge	Not Covered
Maternity Prenatal/Postnatal Care	No Charge	50% after deductible
Rehabilitation Services	$75 deductible waived	50% after deductible
Chiropractic Care	Not Covered	Not Covered
Inpatient Services
Inpatient Hospital	100% after deductible (up to OOP)	50% after deductible
Maternity Delivery/Inpatient	100% after deductible (up to OOP)	50% after deductible
Outpatient Services
Outpatient Facility	100% after deductible (up to OOP)	50% after deductible
Mental Health Outpatient	No charge	50% after deductible
Lab/X-Ray	$40 deductible waived/100% after deductible	50% after deductible
Emergency Care
Emergency Room	100% after deductible (up to OOP)	Paid as in-network
Urgent Care	$75 deductible waived 1st 3 visits	50% after deductible
Ambulance	100% after deductible (up to OOP)	Paid as in-network
Prescription Drugs
Rx Deductible	$500 individual/$1000 family	N/A
Rx Generic	100% after deductible (up to OOP); $500 max/script	Not covered
Rx Preferred	100% after deductible (up to OOP); $500 max/script	Not covered
Rx Non-Preferred	100% after deductible (up to OOP); $500 max/script	Not covered
Recovery/ Special Needs
Home Health Care	100% after deductible (up to OOP); 100 visits per year	Not covered
Durable Medical Equipment	100% after deductible (up to OOP)	Not covered

Optional Benefits	None	None

Complete Benefit Summary

If you you have questions about the Health Net Bronze 60 PPO plan or any other plans from Health Net of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans.

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3761 Bernard Street | Bakersfield, CA 93306
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