|
The Health Net Individual Simple Value plans have very low premiums and offer protection against major financial ruin from catastrophic medical care cost. However, be aware that these plans have VERY HIGH out-of-pocket maximums/limits and offer NO maternity coverage.
Positive Features of these Health Net Insurance Plans:
- Low monthly premium payments to Health Net of CA;
- No calendar year deductible;
- Choice of either generic only or generic and brand medications;
- $30, $40 or $50 doctor office visits with no deductible.
Not-So-Good Features;
- Maternity coverage is NOT included;
- High out-of-pocket limit ($7,500 per person);
- Single Only coverage (no family plans which limits family co-payments and out-of-pocket maximums.)
Health Net of California offers 3 different Simple Value Plans (all benefits shown are in-network, which means that you obtain treatment from doctors and hospitals that have agreed to limit their fees to Health Net members):
- $30 for doctor office visits;
- 30% of charges for x-rays, lab work and other services not included in the doctor office visit charge;
- $400 per day in the hospital (maximum $1,600) PLUS 30% of charges;
- Co-Pay Limit (Out-of-Pocket Maximum) of $7,500;
- Prescription medicine (Rx) either: $10 for generic only, or Combo - $10 generic, brand deductible of $750 then $35 for brand Rx on the formulary or $50 or 50% for brand Rx not on the formulary list.
- $30 for doctor office visits;
- 40% of charges for x-rays, lab work and other services not included in the doctor office visit charge;
- $400 per day in the hospital (maximum $1,600) PLUS 40% of charges;
- Co-Pay Limit (Out-of-Pocket Maximum) of $7,500;
- Prescription medicine (Rx) either: $10 for generic only, or Combo - $10 generic, brand deductible of $750 then $35 for brand Rx on the formulary or $50 or 50% for brand Rx not on the formulary list.
- $30 for doctor office visits;
- 50% of charges for x-rays, lab work and other services not included in the doctor office visit charge;
- $400 per day in the hospital (maximum $1,600) PLUS 50% of charges;
- Co-Pay Limit (Out-of-Pocket Maximum) of $7,500;
- Prescription medicine (Rx) either: $10 for generic only, or Combo - $10 generic, brand deductible of $750 then $35 for brand Rx on the formulary or $50 or 50% for brand Rx not on the formulary list.
When you have paid a total of $7,500 (excluding non-approved charges and excluding money you pay for Rx) Health Net will pay 100 percent of the charges for medical services, subject to the exclusions and limitations described in the Evidence of Coverage.
These plans compete directly with the Blue Cross of California Right Plan 40 and the Blue Shield of California Active Start 25 and 35 plans. Click here to obtain a health insurance quote in California and compare benefits and prices . These plans can be a good way to obtain health insurance in California for a low monthly payment – just know what you are buying and why the monthly payment is low.
Remember that this article merely summarizes the benefits as available July 31, 2006. Please refer to the Evidence of Coverage and the Summary of Benefits from Health Net of California for detailed benefit information.
|