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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.

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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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