Health Net of California, Inc
Minimum Coverage Ambetter HSP
Plan Overview
Combined Medical and Drug Deductible |
|
Combined Medical and Drug Out of Pocket Maximum |
|
Office Visit
Primary Doctor |
|
Specialist |
|
Prescription Drug Information
Preferred Brand Drugs |
|
Non Preferred Brand Drugs |
|
Generic Drugs |
|
Specialty Drugs |
|
Inpatient Coverage
Hospital Services |
|
Inpatient Services |
|
Emergency and Urgent Care
Emergency Room |
|
Urgent Care Facility |
|
Maternity
Labor and Delivery Hospital Stay |
|
Pre and Postnatal Office Visit |
|
Vision
Routine Eye Exams For Children |
|
Major Dental Care
Routine Dental Checkups for Children |
|
Your actual effective date may be different from your requested effective date. Your actual effective date is subject to you meeting the regulatory requirements for a "Special Enrollment Qualifying Event." In order to qualify for a "Special Enrollment," you must show proof of your qualifying event
(e.g., if your qualifying event is a marriage, you must provide a copy of your marriage license, etc.). You must submit all supporting documentation WITH your application. Applications submitted without appropriate documentation cannot be processed. All documents (application and supporting documentation) must be submitted at the same time and through the same method (online application, envelope/email/fax). If supporting documentation is sent separate from the application there is no guarantee that it will be matched to the application.
Community Care HMO plans, offered by Health Net of California, are pending regulatory approval by the Department of Managed Health Care.
The premium rates quoted are subject to change.
HMO Coverage is provided by Health Net of California, Inc., PPO Insurance Plans are underwritten by Health Net Life Insurance Company.
Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net® is a registered trademark of Health Net, Inc.
(e.g., if your qualifying event is a marriage, you must provide a copy of your marriage license, etc.). You must submit all supporting documentation WITH your application. Applications submitted without appropriate documentation cannot be processed. All documents (application and supporting documentation) must be submitted at the same time and through the same method (online application, envelope/email/fax). If supporting documentation is sent separate from the application there is no guarantee that it will be matched to the application.
Community Care HMO plans, offered by Health Net of California, are pending regulatory approval by the Department of Managed Health Care.
The premium rates quoted are subject to change.
HMO Coverage is provided by Health Net of California, Inc., PPO Insurance Plans are underwritten by Health Net Life Insurance Company.
Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net® is a registered trademark of Health Net, Inc.
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