March 19, 2010

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Health Net Farm Bureau – CFB Lifestyle II $4,000 3-Tier Rx – CALIFORNIA

A comparison of the CFB Lifestyle II $4,000 3-Tier Rx offered by Health Net Farm Bureau is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application CFB Lifestyle II $4,000 3-Tier Rx Application CFB Lifestyle II $4,000 3-Tier Rx Application
Brochure CFB Lifestyle II $4,000 3-Tier Rx Brochure CFB Lifestyle II $4,000 3-Tier Rx Brochure
Copay $40 copay (deductible waived for first 4 visits of any combination of professional services and preventive care) 50% after deductible is met
Office Visit $40 copay (deductible waived for first 4 visits of any combination of professional services and preventive care) 50% after deductible is met
Deductible Individual: $4,000 per member, Family: $8,000 per family Individual: $4,000 per member, Family: $8,000 per family
Coinsurance 100% after deductible is met 50% after deductible is met
Coinsurance Limit CFB Lifestyle II $4,000 3-Tier Rx CFB Lifestyle II $4,000 3-Tier Rx
Out-of-Pocket Maximum $0 (Does not include deductible)Individual: $7,500 per member, Family: $15,000 per family
Lifetime Maximum $6,000,000 $6,000,000
Prescription Drugs
  • Generic- $5 copay
  • Brand Deductible- $500
  • Preferred Brand- $35 copay
  • Non-preferred Brand- 50% or $50 (whichever is greater)
    		•  Not Covered
    Emergency Room No charge after deductible is met 50% after deductible is met
    Adult Preventative Care $40 copay (deductible waived for first 4 visits of any combination of professional services and preventive care) Not Covered
    Child Preventative Care $40 copay (deductible waived for first 4 visits of any combination of professional services and preventive care) Not Covered
    Lab / X-Ray No charge after deductible is met 50% after deductible is met
    Maternity No charge after deductible is met 50% after deductible is met
    Physical Therapy
  • Chiropractic Care- No charge after calendar year deductible is met (12 visits per calendar year combined with acupuncture, in- or out-of-network)
  • Acupuncture / Acupressure- No charge after calendar year deductible is met (12 visits per calendar year combined with chiropractic care, in- or out-of-network)
    		•
  • Chiropractic Care- 50% (12 visits per calendar year combined with acupuncture, in- or out-of-network)
  • Acupuncture / Acupressure- 50% (12 visits per calendar year combined with chiropractic care, in- or out-of-network)
    		•
    Skilled Nursing CFB Lifestyle II $4,000 3-Tier Rx CFB Lifestyle II $4,000 3-Tier Rx
    Home Health Care See benefits contract See benefits contract
    Mental Health CFB Lifestyle II $4,000 3-Tier Rx CFB Lifestyle II $4,000 3-Tier Rx
    Hospital Care CFB Lifestyle II $4,000 3-Tier Rx CFB Lifestyle II $4,000 3-Tier Rx
    Optional Benefits CFB Lifestyle II $4,000 3-Tier Rx CFB Lifestyle II $4,000 3-Tier Rx