California Health Insurance: Health Net Platinum 90 PPO

Health Net Platinum 90 PPO


Cost Share Information 
Individual Deductible  $0 $5,000
Family Deductible  $0 $10,000
Out of Pocket Limit-Individual  $4,000 $25,000
Out of Pocket Limit-Family  $8,000 $50,000
Co-Insurance  10% 50% 
Lifetime Maximum  Unlimited Unlimited
Primary Care  $15 50%
Specialist  $40 50%
Adult Preventive Care  No Charge Not Covered 
Child Preventive Care  No Charge Not Covered 
Maternity Prenatal/Postnatal Care  No Charge 50%
Rehabilitation Services  $15 Not covered
Chiropractic Care  Not Covered  Not Covered 
Inpatient Services 
Inpatient Hospital 10% 50% after deductible 
Maternity Delivery/Inpatient  10% 50% after deductible 
Outpatient Services 
Outpatient Facility  10%   50% after deductible
Mental Health Outpatient  No charge 50% after deductible
Lab/X-Ray  $20/$40 50% after deductible
Emergency Care 
Emergency Room  $150 (waived if admitted) Paid as in-network
Urgent Care  $15  50%
Ambulance  $150  Paid as in-network
Prescription Drugs 
Rx Deductible  N/A N/A 
Rx Generic  $5 Not covered 
Rx Preferred  $15 Not covered 
Rx Non-Preferred  $25 Not covered 
Recovery/ Special Needs 

Home Health Care

10%; 100 visits per year

Not covered 

Durable Medical Equipment  10% Not covered 
Optional Benefits  None  None 

Complete Benefit Summary

If you you have questions about the Health Net Platinum 90 PPO 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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