New Health Net Next Generation Health Plans- March 2012
Item 1: Health Net SmartCare – first innovation for 2012
A pioneer in the creation of tailored networks, Health Net is evolving its Bronze plans and network into Health Net SmartCare. Your clients can get the advantages of a tailored network, expanded benefits and health incentives in one simple package.More ways to protect health:
- Convenient CVS MinuteClinics;
- Acupuncture and chiropractic services included as valued-added benefits; and
- Health incentives to help employees be well and productive.
More relevant to your clients:
- Easy-to-understand, choose, and use HMO plans keep decision making clear and simple.
- Sets employers up for the long-term. SmartCare is built to flex over time with planned expansions for 2012 (and beyond) in geographic coverage, prominent participating provider groups and other resources to match evolving employer and employee needs.
Health Net SmartCare is the health care solution that employers can afford, employees will use, and both will value.
Creating an easy migration from Bronze to SmartCare
Effective March 1, 2012, Health Net will no longer offer Bronze or Bronze Choice to new groups. Groups currently enrolled in a Bronze plan will be:
- Notified 90 days in advance of their renewal date by letter that explains the change.
- Offered the option to choose any one or more of the new SmartCare plans (six for SBG, five for Large), or any other Health Net group plan.
If a group wants to keep their plan design exactly as it is under their Bronze plan, they may do so by pairing those benefits with Health Net’s full HMO or Silver network.
Health Net has the Health Net SmartCare broker guide including a crosswalk and plan overviews available to support you and your brokers in client conversations.
Click here for SmartCare HMO Plans.
Item 2: Lower SBG PPO Advantage plan rates – San Diego
In conjunction with introducing SmartCare in San Diego (region 7), Health Net is also lowering rates for its PPO Advantage plans.
Item 3: Salud expands into Kern county
Health Net is expanding its Salud network with the addition of IPA Hispanic Physicians, which has eight PCPs and 74 specialists. The expansion makes Salud HMO y Más and Salud Mexico available to groups – both SBG and Large – in parts of Kern county effective March 1, 2012. More information and details about materials will be sent soon.
Health Net Introduces “Dual Networks” Effective 5/1/2011
Health Net is debuting an expanded, dual network small business group plan portfolio called, “Offer More, Spend Less.” The dual network approach allows mixing and matching for just the right combination of coverage and price.
Small business clients will be able to offer a selection of full network and tailored network plans to their employees.
- Pick one or more of four new full network HMO plans. These plans were modeled after those most favored by Health Net’s small business groups. The chart below shows a summary of the difference in benefits.
| HMO 20 STD | DUAL NET HMO 20 STD | HMO 30 STD | DUAL NET HMO 30 STD | |
| MHPA plan code | 1RX | 5NP | 1RY | 5NQ |
| Non-MHPA plan code | 1EK | 5NK | 1EL | 5NL |
| Specialist Consultation | $20 | $30 | $30 | $40 |
| Emergency Room | $100 | $150 | $100 | $150 |
| HMO 30 VALUE | DUAL NET HMO 30 VALUE | HMO 40 VALUE | DUAL NET HMO 40 VALUE | |
| MHPA plan code | 1SR | 5NR | 1ST | 5NN |
| Non-MHPA plan code | 1EQ | 5NM | 1ER | 5NJ |
| Specialist Consultation | $30 | $50 | $40 | $60 |
| Emergency Room | $100 | $150 | $100 | $150 |
2. Once you’ve selected the full network HMO plan(s), you can bundle them with either the Silver Choice or Bronze Choice portfolio.
These plans are now available for quoting. For more details on the new plan designs, click on the PDFs below.
More Standard and Value Designs
Health Net is also expanding their Standard and Value plan collections with more coverage/cost combinations for today’s small business owner.
- Standard PPO Plans: four new choices
- HMO and EOA: four more of each with choice of network
- Value PPO Plans: four new choices
- New $50 copayment plan in either an HMO or EOA
HRA Plan Benefit Enhancement
Also new for May 1, 2011, Health Net is enhancing their HRA plans. Members now have benefit coverage for in-network doctor visits at a set 50% coinsurance after their deductible is met.
New, Lower-cost PPO Dental Plans
Three of them to be exact. Healthy teeth are important, and so is making it easy and affordable for employers to provide dental coverage for their employees. For example, the Essential Value plan delivers savings by including endodontics, periodontics and major oral surgery under major benefits. Plus, all of the new plans include health promoting features like extra services for pregnant women.
Rates are effective May 1, 2011 through July 15, 2011 effective dates.
| 5.11 – HN Ancillary Programs Brochure.pdf |
| 5.11 HN Benefits Guide.pdf |
| 5.11 – HN Dual Network Option Brochure.pdf |
This document is not intended to be authoritative, and its accuracy is not guaranteed. It is believed to be correct at the time of its printing. Any questions about official interpretations of the law should be directed to legal counsel.
Health Net drops rates for California Small Group | Changes for Oct & Nov 2010!
 Effective 10/1! Health Net has made the following changes:
Effective 11/1! Health Net is making the following area changes:
SIC 10% Discount
PPO MEDICAL RATING REGIONS Region 1 Includes the following El Dorado ZIP codes: 95613-14, 95619, 95623, 95629, 95633-36, 95643, 95651, 95656, 95664, 95684, 95709, 95720-21, 95726-27, 95735, 96142, 96150-58 only, and Amador, Butte, Calaveras, Colusa, Glenn, Humboldt, Lake Mendocino, Monterey, Napa, Plumas, Shasta, Sierra, Sutter, Tehama, Tulare, Tuolumne and Yuba counties Region 2 Includes the following El Dorado ZIP codes: 95667, 95672, 95682 and 95762 only, and Marin, Mariposa, Merced, Nevada, San Benito, San Joaquin, Santa Cruz, Solano, Sonoma, Stanislaus and Yolo counties Region 3 Contra Costa, Kings, Madera, Placer, Sacramento, San Francisco and San Mateo counties Region 4 Kern, Santa Barbara and Ventura counties Region 5 Includes the Los Angeles ZIP codes beginning with 906-912, 915, 917, 918, and 935 only, Riverside and San Bernardino counties Region 6 Orange and San Luis Obispo counties Region 7 San Diego and Imperial counties Region 8 Includes the Los Angeles ZIP codes beginning with 900-905, 913-914 and 916 only Region 9 Alameda, Fresno and Santa Clara counties HMO MEDICAL RATING REGIONS Region 1 Includes the following El Dorado ZIP codes: 95613-14, 95619, 95623, 95629, 95633-36, 95643, 95651, 95656, 95664, 95684, 95709, 95720-21, 95726-27, 95735, 96142, 96150-58 only, Napa and Tulare counties Region 2 Includes the following El Dorado ZIP codes: 95667, 95672, 95682 and 95762 only, and Marin, Merced, Nevada, San Joaquin, Santa Cruz, Solano, Sonoma, Stanislaus and Yolo counties Region 3 Contra Costa, Kings, Madera, Placer, Sacramento, San Francisco and San Mateo counties Region 4 Santa Barbara and Ventura counties Region 5 Includes the Los Angeles ZIP codes beginning with 906-912, 915, 917, 918, and 935 only, Riverside and San Bernardino counties Region 6 Kern and Orange counties Region 7 San Diego Region 8 Includes the Los Angeles ZIP codes beginning with 900-905, 913-914 and 916 only Region 9 Alameda, Fresno and Santa Clara counties |
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| This document is not intended to be authoritative, and its accuracy is not guaranteed. It is believed to be correct at the time of its printing. Any questions about official interpretations of the law should be directed to legal counsel. |
