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California Health Insurance: Health Net Gold 80 EPO

California Health Insurance: Health Net Gold 80 EPO

Health Net Gold 80 EPO

In-Network

Cost Share Information 
Individual Deductible  $0
Family Deductible  $0
Out of Pocket Limit-Individual  $6,750
Out of Pocket Limit-Family  $13,500
Co-Insurance  20%
Lifetime Maximum  Unlimited
Office Visits 
Primary Care  $30
Specialist  $55
Adult Preventive Care  No Charge
Child Preventive Care  No Charge
Maternity Prenatal/Postnatal Care  No Charge
Rehabilitation Services  $30
Chiropractic Care  Not Covered 
Inpatient Services 
Inpatient Hospital $600 per day; 5 days/admit
Maternity Delivery/Inpatient  $600 Per day; 5 days/admit
Outpatient Services 
Outpatient Facility  20%
Mental Health Outpatient  No charge
Lab/X-Ray  $35/$55
Emergency Care 
Emergency Room  $325 (waived if admitted)
Urgent Care  $30  
Ambulance  $250 
Prescription Drugs 
Rx Deductible  N/A
Rx Generic  $15
Rx Preferred  $55
Rx Non-Preferred  $75
Recovery/ Special Needs 

Home Health Care

20%; 100 visits per year

Durable Medical Equipment  20%
 
Optional Benefits  None 

Complete Benefit Summary


If you you have questions about the Health Net Gold 80 EPO plan or any other plans from Health Net of California please call The Lynn Company at (800)-326-5966 for more information on California Health Insurance Plans
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