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Health Net Minimum Coverage PPO

Health Net Minimum Coverage PPO

 

Health Net Minumum Coverage PPO

In-Network

 Out-Network
Cost Share Information 
Individual Deductible  $7,150 $14,300
Family Deductible  $14,300 $28,600 
Out of Pocket Limit-Individual  $7,150 (including deductible) $25,000 (including deductible) 
Out of Pocket Limit-Family  $14,300 (including deductible) $50,000 (including deductible) 
Co-Insurance  0% 50% 
Lifetime Maximum  Unlimited Unlimited
Office Visits 

Primary Care 

0% deductible waived 1st 3 visits 

50% after deductible
Specialist  0% after deductible 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  0% after deductible Not Covered  
Chiropractic Care  Not Covered  Not Covered 
Inpatient Services 
Inpatient Hospital 0% after deductible  50% after deductible
Maternity Delivery/Inpatient  0% after deductible  50% after deductible 
Outpatient Services 
Outpatient Facility  0% after deductible  50% after deductible 

Mental Health Outpatient 

0% deductible waived 1st 3 visits

50% after deductible 
Lab/X-Ray  0% after deductible  50% after deductible 
Emergency Care 
Emergency Room  0% after deductible  Paid as in-network

Urgent Care 

0% deductible waived 1st 3 visits

50% after deductible 
Ambulance  0% after deductible  Paid as in-network 
Prescription Drugs 
Rx Deductible  Integrated Medical/Rx  N/A 
Rx Generic  0% after deductible Not covered 
Rx Preferred  0% after deductible Not covered 
Rx Non-Preferred  0% after deductible  Not covered 
Recovery/ Special Needs 

Home Health Care 

0% after deductible;

100 visits per year 

Not covered 
Durable Medical Equipment  0% after deductible  Not covered
 
Optional Benefits  None  None 

Complete Benefit Summary

If you you have questions about the Health Net Minimum Coverage 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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