Health Net CA Silver, Bronze, Platinum & Gold Plans
Individual & Family Plan Information 

HN #Network Definitions

• 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.
• 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.
  • Plans that don’t seem to be offered for 2023 Individual & Family
• 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).
  • 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/}
    • • • wikipedia.org/Exclusive_provider_organization
• 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.
• 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}
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