March 13, 2010

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Health Net Arizona – High Deductible PPO $2,600/100% – ARIZONA

A comparison of the High Deductible PPO $2,600/100% offered by Health Net Arizona is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application High Deductible PPO $2,600/100% Application High Deductible PPO $2,600/100% Application
Brochure High Deductible PPO $2,600/100% Brochure High Deductible PPO $2,600/100% Brochure
Copay 100%, Subject to deductible 50%, Subject to deductible
Office Visit 100%, Subject to deductible 50%, Subject to deductible
Deductible Individual: $2,600, Family: $5,150 Individual: $5,200, Family: $10,300
Coinsurance 100% 50%
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $0, Family: $0 (Excludes deductible) Individual: $4,800, Family: $9,700 (Excludes deductible)
Lifetime Maximum $5,000,000 (In and out-of-network combined) $5,000,000 (In and out-of-network combined)
Prescription Drugs Outpatient Prescription Drugs (up to a 31-day supply):
  • 100%, Subject to deductible
Self-injectable Drugs (tier 2 copayment will apply to preferred insulins):
  • 100%, Subject to deductible
 Outpatient Prescription Drugs (up to a 31-day supply):
  • Out-of-area emergencies only
Self-injectable Drugs (tier 2 copayment will apply to preferred insulins):
  • Out-of-area emergencies only
Emergency Room 100%, Subject to deductible 100%, Subject to deductible
Adult Preventative Care Preventive Care (Routine physicals, annual GYN exams, immunizations and vision and hearing screenings): 100%, Subject to deductible. No charge for first $300 Preventive Care (Well-baby care, immunizations and vision and hearing screenings): 50%, Subject to deductible (Does not apply to ages 0 through 4)
Child Preventative Care Preventive Care (Well-baby care, immunizations and vision and hearing screenings): 100%, Subject to deductible. No charge for first $300 (Does not apply to ages 0 through 4) Preventive Care (Well-baby care, immunizations and vision and hearing screenings): 50%, Subject to deductible (Does not apply to ages 0 through 4)
Lab / X-Ray Outpatient laboratory and X-ray services: 100%, Subject to deductible Outpatient laboratory and X-ray services: 50%, Subject to deductible
Maternity Not covered except for complications of pregnancy Not covered except for complications of pregnancy
Physical Therapy Rehabilitative Services (Limited to short-term, maximum of 60 days per calendar year, all therapies combined): 100%, Subject to deductible Rehabilitative Services (Limited to short-term, maximum of 60 days per calendar year, all therapies combined): 50%, Subject to deductible
Skilled Nursing 100%, Subject to deductible (Limited to 60 days per calendar year) 50%, Subject to deductible (Limited to 60 days per calendar year)
Home Health Care N/A N/A
Mental Health Mental Health Services (Maximum of 10 visits per calendar year):
  • Inpatient: Not covered
  • Outpatient: 100%, Subject to deductible
 Mental Health Services (Maximum of 10 visits per calendar year):
  • Inpatient: Not covered
  • Outpatient: 50%, Subject to deductible
Hospital Care
  • Inpatient Hospital Services (Including physician, facility, and surgery charges): 100%, Subject to deductible
  • Outpatient Hospital Services: 100%, Subject to deductible
  • Inpatient Hospital Services (Including physician, facility, and surgery charges): 50%, Subject to deductible
  • Outpatient Hospital Services: 50%, Subject to deductible
Optional Benefits see brochure see brochure