California Health Insurance: Health Net Gold 80 PPO

California Health Insurance: Health Net Gold 80 PPO Health Net Gold 80 PPO In-Network Out-Network Cost Share Information  Individual Deductible  $0 $5,000 Family Deductible  $0 $10,000 Out of Pocket Limit-Individual  $6,750 $25,000 Out of Pocket Limit-Family  $13,500 $50,000 Co-Insurance  20% 50%  Lifetime Maximum  Unlimited Unlimited Office Visits  Primary Care  $30 50% after deductible Specialist  $55 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  $30 Not Covered Chiropractic Care  Not Covered  Not Covered  Inpatient Services  Inpatient Hospital 20% 50% after deductible  Maternity Delivery/Inpatient  20% 50% after deductible  Outpatient Services  Outpatient Facility  20%   50% after deductible Mental Health Outpatient  No charge 50% after deductible  Lab/X-Ray  $35/$55 50% after deductible Emergency Care  Emergency Room  $325 (waived if admitted) Paid as in-network Urgent Care  $30   50% after deductible Ambulance  $250  Paid as in-network Prescription Drugs  Rx Deductible  N/A N/A  Rx Generic  $15 Not covered  Rx Preferred  $55 Not covered  Rx Non-Preferred  $75 Not covered  Recovery/ Special Needs  Home Health Care 20%; 100 visits per year Not covered  Durable Medical Equipment  20% 50% after deductible    Optional Benefits  None  None  Complete Benefit Summary If you you have questions about the Health Net Gold 80 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.