Instant Health Net ONLINE Quotes & Enrollment

Instructions to use HN Provider Search Tool
Instructions to use HN Provider Search Tool

ONLINE Provider Search

Guide – 8 page pdf for brokers 4.2015

Public 1.2015

Understanding your Explanation of Benefits (EOB) 5.2015

Commercial Claim Form  English 03/31/15

HMO/POS Travel Guide English    06/19/15     PPO  English  04/16/15

2015 Health Net dropping PPO? ♦  More and new HSP plan ♦ HN Official Agent Notification ♦  Agent Announcement for 2015

 

wikipedia.org/Exclusive_provider_organization

In the United States, an exclusive provider organization is a hybrid health insurance plan in which a primary care provider is not necessary, but in which health care providers must be seen within a predetermined network. Out of network care is not provided, and visits require pre-authorization. Doctors are paid as a function of care provided, as opposed to an HMO. In an EPO, the payment scheme is usually fee for service, in contrast to HMOs. In the latter, the healthcare provider is paid by capitation, and receives a monthly fee regardless of whether or not the patient is seen.[1]

healthcare.gov/exclusive-provider-organization-epo-plan/

healthcare.gov/plan-types/

  • Exclusive Provider Organization (EPO):A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
  • Health Maintenance Organization (HMO):A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
  • Point of Service (POS):A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
  • Preferred Provider Organization (PPO):A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

2015 IFP portfolio

For 2015, we will offer:

  • Two new tailored network-based plans.
    • A Health care service plan (HSP) Pure Care Network in Southern California (on- and off-exchange).
      • Health Care Service Plan (HSP) is a benefit plan using health care provider arrangement whereby an entity, such as Health Net, contracts with a group of Physicians or other medical care providers, called Participating Providers, who agree to furnish services at the negotiated rate known as the Contracted Rate.  Bronze EOC Page 119
      • Health Net PureCare HSP Service Area is the geographic area in California where Health Net has been authorized by the California Department of Managed Health Care to contract with providers, market products, enroll Members and provide benefits through approved Individual HSP health plans. A listing of the Participating Providers in the Health Net PureCare HSP Service Area, including Primary Care Physicians, are available on the Health Net website at www.healthnet.com. You can also call the Customer Contact Center at the number shown on your Health Net I.D. Card to request provider information.Bronze EOC Page 119
    • An Exclusive Provider Organization (EPO) plan in Northern California (on- and off-exchange except in Mariposa, Monterey and San Benito counties). We are awaiting regulatory approval.
  • HMO plans in Southern California (on- and off-exchange) using our CommunityCare network. We will continue to offer these popular HMO plans in platinum, gold and silver metal levels.

 

Related Pages in Health Net  Section

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