California Health Insurance: Health Net Silver 70 PPO

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California Health Insurance: Health Net Silver 70 PPO

Health Net Silver 70 PPO	In-Network	Out-Network
Cost Share Information
Individual Deductible	$2,500	$5,000
Family Deductible	$5,000	$10,000
Out of Pocket Limit-Individual	$6,800 (including deductible)	$25,000 (including deductible)
Out of Pocket Limit-Family	$13,600 (including deductible)	$50,000 (including deductible)
Co-Insurance	20%	50%
Lifetime Maximum	Unlimited	Unlimited
Office Visits
Primary Care	$35 deductible waived	50% after deductible
Specialist	$70 deductible waived	50% after deductible
Adult Preventive Care	No Charge	Not Covered
Child Preventive Care	No Charge	Not Covered
Maternity Prenatal/Postnatal Care	No Charge	50% after deductible
Rehabilitation Services	$35 deductible waived	Not covered
Chiropractic Care	Not Covered	Not covered
Inpatient Services
Inpatient Hospital	20% after deductible	50% after deductible
Maternity Delivery/Inpatient	20% after deductible	50% after deductible
Outpatient Services
Outpatient Facility	20%deductible waived	50% after deductible
Mental Health Outpatient	No charge	50% after deductible
Lab/X-Ray	$35/$70 deductible waived	50% after deductible
Emergency Care
Emergency Room	$350 (waived if admitted) deductible waived	Paid as in-network
Urgent Care	$35 deductible waived	50% after deductible
Ambulance	$250 after deductible	Paid as in-network
Prescription Drugs
Rx Deductible	$250 individual/ $500 family	N/A
Rx Generic	$15 deductible waived	Not covered
Rx Preferred	$55 after deductible	Not covered
Rx Non-Preferred	$80 after deductible	Not covered
Recovery/ Special Needs
Home Health Care	$45 deductible waived; 100 visits per year	Not covered
Durable Medical Equipment	20% after deductible	Not covered

Optional Benefits	None	None

Complete Benefit Summary

If you you have questions about the Health Net Silver 70 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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