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Health Net Bronze 60 PPO

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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