March 20, 2010

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Health Net California – Salud PPO 15 – CALIFORNIA

A comparison of the Salud PPO 15 offered by Health Net California is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Application Salud PPO 15 Application Salud PPO 15 Application
Brochure Salud PPO 15 Brochure Salud PPO 15 Brochure
Copay
  • Visit to physician (including specialist consultations)- $15 (deductible waived)
    		•  N/A
    Office Visit
  • Visit to physician (including specialist consultations)- $15 (deductible waived)
    		•  50% after deductible
    Deductible $1,500 single/2 per family $3,000 single/2 per family
    Coinsurance 100% 50%
    Coinsurance Limit Annual out-of-pocket maximum- Each member must meet calendar deductible only/2 per family Annual out-of-pocket maximum- Each member must meet calendar deductible only/2 per family
    Out-of-Pocket Maximum Annual out-of-pocket maximum- Each member must meet calendar deductible only/2 per family Annual out-of-pocket maximum- Each member must meet calendar deductible only/2 per family
    Lifetime Maximum $6,000,000 combined $6,000,000 combined
    Prescription Drugs
  • Prescription drugs filled at a participating pharmacy (up to a 30-day supply)- $5 Level 1 (generic)/$35 Level 2 (primarily brand)/$50 Level 3 (or drugs not listed on the recommended drug list).
  • $150 Brand deductible
  • Prescription drugs filled through mail order, up to a 90-day supply, are available in California only and require twice the level of copayment).
    		•  Not covered
    Emergency Room Covered in full after deductible is met. Covered in full after deductible is met.
    Adult Preventative Care
  • Annual OB/GYN (breast and pelvic exams, Pap smears and mammography)/Annual prostate cancer screening and exam- $15 (deductible waived)
    		•
  • Child preventive care (newborns to age 18)- Not Covered
  • Checkups, immunizations, vision and hearing exams- Not Covered
    		•
    Child Preventative Care
  • Child preventive care (newborns to age 18)- $15 (deductible waived)
  • Checkups, immunizations, vision and hearing exams- $15 (deductible waived)
    		•
  • Child preventive care (newborns to age 18)- Not Covered
  • Checkups, immunizations, vision and hearing exams- Not Covered
    		•
    Lab / X-Ray
  • X-ray and laboratory procedures- Covered in full after deductible is met.
    		•
  • X-ray and laboratory procedures- 50% after deductible
    		•
    Maternity
  • Prenatal and postnatal office visits- Covered in full after deductible is met.
  • Maternity care in hospital or skilled nursing facility- Covered in full after deductible is met.
    		•
  • Prenatal and postnatal office visits- 50% after deductible
  • Maternity care in hospital or skilled nursing facility- 50% after deductible
    		•
    Physical Therapy Salud PPO 15 Salud PPO 15
    Skilled Nursing Salud PPO 15 Salud PPO 15
    Home Health Care Salud PPO 15 Salud PPO 15
    Mental Health
  • Semiprivate hospital room or intensive care unit with ancillary services (unlimited, except for non-severe mental health and chemical dependency treatment)- Covered in full after deductible is met.
    		•
  • Semiprivate hospital room or intensive care unit with ancillary services (unlimited, except for non-severe mental health and chemical dependency treatment)- 50% after deductible
    		•
    Hospital Care
  • Surgeon or assistant surgeon and anesthetic service (inpatient hospital setting)- Covered in full after deductible is met.
  • Outpatient surgery (hospital or outpatient surgery center charges only)- Covered in full after deductible is met.
  • Outpatient facililty services (other than surgery)- Covered in full after deductible is met.
    		•
  • Surgeon or assistant surgeon and anesthetic service (inpatient hospital setting)- 50% after deductible
  • Outpatient surgery (hospital or outpatient surgery center charges only)- 50% after deductible
  • Outpatient facililty services (other than surgery)- 50% after deductible
    		•
    Optional Benefits Salud PPO 15 Salud PPO 15