Health Net Gold 80 HMO

Health Net Gold 80 HMO Health Net Gold 80 HMO In-Network Cost Share Information  Individual Deductible  $0 Family Deductible  $0 Out of Pocket Limit-Individual  $6,750 Out of Pocket Limit-Family  $13,500 Co-Insurance  20% Lifetime Maximum  Unlimited Office Visits  Primary Care  $30 Specialist  $55 Adult Preventive Care  No Charge Child Preventive Care  No Charge Maternity Prenatal/Postnatal Care  No Charge Rehabilitation Services  $30 Chiropractic Care  Not Covered  Inpatient Services  Inpatient Hospital $600 per day; 5 days/admit Maternity Delivery/Inpatient  $600 Per day; 5 days/admit Outpatient Services  Outpatient Facility  $600 Mental Health Outpatient  $30 Lab/X-Ray  $35/$55 Emergency Care  Emergency Room  $325 (waived if admitted) Urgent Care  $30   Ambulance  $250  Prescription Drugs  Rx Deductible  N/A Rx Generic  $15 Rx Preferred  $55 Rx Non-Preferred  $75 Recovery/ Special Needs  Home Health Care $30; 100 visits per year Durable Medical Equipment  20%   Optional Benefits  None  Complete Benefit Summary If you you have questions about the Health Net Gold 80 HMO 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.