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California Health Insurance: Health Net Gold 80 EPO

Health Net Gold 80 EPO	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	20%
Mental Health Outpatient	No charge
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	20%; 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 EPO 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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Please note that we cannot bind insurance via email, fax, or voicemail. Any quotes given are subject to underwriting guidelines by the respective insurance carriers. Any reference of coverage used are not intended to express legal opinion as to the nature of coverage, but rather just a brief generalization of coverages. Please read your policy for coverage details.

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3761 Bernard Street | Bakersfield, CA 93306
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