Commercial Health Net Life Insurance Company (Health Net) Health Net PPO Freedom of Choice Jesus Hao Health Net
For more than 35 years, Health Net has helped individuals and families get the health care they need. Our PPO plans are a perfect blend of what you want choice and flexibility with benefits, services and resources designed to help you be your healthiest. You have the freedom to choose from our broad network of PPO doctors, specialists, hospitals, and pharmacies with no referral required! You can also choose to visit a doctor outside the network for covered services; however, your out-of-pocket costs are generally lower when you use doctors and facilities within our PPO network. There are no claim forms to file when you use in-network providers and pharmacies. And when you choose Health Net PPO, you can count on programs and services that make it easy for you to take care of your health and get the most from your plan. Read more about what our PPO plans offer and how Health Net makes health care work for you! 2
Health Net PPO network Our PPO network is one of the largest in California. 1 Our statewide network is made up of local doctors, hospitals and pharmacies that make it easier for you and your family to get the care you need when you need it. Physicians, specialists and health professionals: More than 68,000 Hospitals: More than 310 Pharmacies: More than 6,000 statewide and 65,000 nationwide CVS MinuteClinics across California Behavioral health providers: More than 4,300 Health Net s national network: First Health 2 With a Health Net PPO insurance plan, you have the peace of mind knowing that you re covered throughout the United States. Through our national PPO network partner, First Health, Health Net PPO members residing or traveling outside of California may obtain in-network services from participating First Health providers. Primary care physicians: More than 100,900 (internal medicine and general practice) Pediatricians: More than 36,700 OB/GYNs: More than 27,300 Other specialists: More than 531,000 Hospitals: More than 4,400 general/acute care and 800 rehabilitation/long-term care Travel program Wherever our PPO members go, we have them covered! Our members and their covered dependents have access to quality health care while traveling. Members are covered for urgent care and emergency services received from licensed providers and treatment centers anywhere in the world. Our Travel Guide gives instruction about how to seek appropriate care while traveling. A direct call service helps our members contact us from whatever country they are visiting. Decision Power : Health & Wellness Health Net s Decision Power gives our members personalized tools along with the support and confidence to take action for positive, lasting health changes. Decision Power allows our members to: Get help with a specific health goal. Track diet, exercise or cholesterol. Try online health promotion programs. Learn about health risks. Explore treatment options. Adapt to living with illness. Visit www.healthnet.com and select the ProviderSearch tool to find doctors and hospitals in our PPO network. Learn more important information about First Health! See the First Health: National PPO Network section of this brochure. 3
Transition Care Management Program You can join Health Net even if you re currently in treatment. We ll help you transition your current medical care treatments and maintenance prescriptions so you do not experience a gap in service when you are switching plans, doctors or medical groups. Commitment to quality At Health Net, we strongly believe in supporting the health and wellness needs of our members through every age and stage of life. Being your Health Net means that we are here to help you get well and stay healthy. We want you to have the support you need in ways that work for you. No matter what level of coverage you need for your lifestyle, family and budget We have you covered! Our plans come with preventive care and value-added wellness programs, including: Wellness program mystrength: for your mind, body and spirit mystrength is a confidential online resource we offer our members, which is personalized to help improve your mood. This self-help resource is designed to help empower you to become and stay mentally and physically healthy. This valuable resource offers in-themoment mood tracking, and it offers you immediate stressrelief activities that can help you achieve lasting, healthy change. Why mystrength? A variety of mood-improving resources. Step-by-step elearning modules. Interactive tools. Weekly action plans. Daily inspiration. A site that s highly confidential and HIPAAcompliant for your privacy! All this is included with your Health Net coverage at no additional cost! What mystrength users are saying: It s nice to have self-guided help that is so accessible. It gives me hope and inspiration for my recovery. Welvie: surgery decision-support Welvie is an online surgery decision-support program offered to our members. Welvie s six-step program guides you through the entire surgery process. The program helps you work with your doctor to understand your surgical and non-surgical treatment options. If surgery is the decision, Welvie helps you understand what to expect from pre-op preparations to recovery. Plus, when you complete steps 1 3 of the Welvie program and a brief survey, you ll receive a $25 gift card (one card available per member per 365 days). Why Welvie? Understand how to evaluate the risks and benefits of all your treatment options. Prepare for and recover from a surgical procedure, which can help reduce the chances of a complication or an error, and ensure a better result. The program is included with your Health Net coverage at no additional cost. What Welvie users are saying: I think the program has covered everything very well and [is] very informative. I never knew that I had a choice. After using Welvie, I m considering interviewing my doctors more, being more proactive about asking questions regarding a surgery, recovery and follow-up. 4
First Health: National PPO Network Ready to enroll in Health Net s PPO? When you do, you will have peace of mind knowing that you are covered anytime, anywhere with First Health Health Net s national PPO network. Keep this important information handy regarding using the First Health Network. The First Health Network Find a national provider online Health Net has an arrangement with First Health Net is here to make finding a provider Health, a national network of doctors easy for you. With our ProviderSearch tool, and hospitals throughout the U.S. This you can find a doctor, hospital, urgent care arrangement allows you as a Health Net PPO center, or any provider in our national PPO member to receive health care services at a network quickly. contracted rate whether you reside or travel outside of California. Go to www.healthnet.com and follow these simple steps: Important: When visiting a provider, be sure to show your Health Net ID card (with the First Health logo) to identify yourself as a First Health member. 1. Click on ProviderSearch Find a doctor. 3. Choose and fill in the requested information, and click Search now. 2. Click Search First Health. 5
Choose a First Health provider To ensure you get in-network benefits when visiting a provider for regular services 3 outside of California, identify yourself as a First Health member, or ask the provider if he or she participates in the First Health Network. If you receive care from a provider not contracted with First Health, you may have to pay higher out-of-pocket costs at the time of service and will then need to submit a claim to receive your reimbursement. In case of an emergency, go to the nearest emergency or urgent care facility, even if it is not a contracted Health Net provider. When should I use First Health? Knowing when to use Health Net s national PPO provider network is key to ensuring you pay the lowest out-of-pocket costs possible. This chart will help you decide which network to choose when obtaining regular services. 3 In-state employees Within California Use the Health Net in-state PPO network (in-network tier) Outside California Use the First Health provider network (in-network tier) Through an out-of-network provider Covered 3 (out-of-network tier) Out-of-state employees Within your home state Use the First Health provider network (in-network tier) Outside California Through an out-of-network provider Covered 3 (out-of-network tier) PPO members who have an emergency or urgent situation should go to the nearest emergency or urgent care facility as soon as possible, even if it is not a Health Net or First Health provider (in-network tier). You or a family member should contact Health Net as soon as possible. Geoffrey Gomez, Health Net We re here to support your health goals. 6
Finding a pharmacy is easy Our participating pharmacies include most major national chains, many regional chains and some local independents throughout the country. To find a participating pharmacy, go to www.healthnet.com/mypharmacy and then: 1. Click on Finding a Pharmacy. 2. Click Continue after reading the disclaimer. It will take you to the Pharmacy Locator. Member questions If you have questions or need further assistance finding a provider in our national PPO network, call Health Net s Customer Contact Center at the number located on your ID card, Monday through Friday, 8:00 a.m. to 6:00 p.m. Pacific time. 7
For assistance or more information Call the Health Net Customer Contact Center at the number on your ID card or visit our website at www.healthnet.com. 1 Network data current as of July 2017. 2 Network data current as of March 2017. 3 Please refer to your Certificate of Insurance for exclusions and limitations. Health Net Life Insurance Company is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved. BRO014751EP00 (8/17)