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.

  1. 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:  

  • Stanislaus County – Silver rates will go from a 15% discount to a 25% discount
  • HSA 4000 rates will be lowered 10% statewide
  • HSA 4500 rates will be lowered 15% statewide
  • PPO 40-V rates will be lowered 15% in Los Angeles, Inland Empire, and Orange counties (rating regions 5,6, and 8)
  • HRA rates will be lowered 10% statewide
  • Salud HMO rates will be lowered 5%
  • PPO plan rates in Los Angeles County (rating region 8) will be lowered 8% (this excludes PPO 40-V, HSA 4000, and HSA 4500 whose rates will drop 10-15%) 

Effective 11/1! Health Net is making the following area changes:  

  • El Dorado PPO (split between rating regions 1 and 2 – El Dorado and Marin, Merced, Nevada, etc.) will move to rating region 9 – Alameda, Fresno and Santa Clara counties
  • Marin PPO (rating region 2 ) will move to rating region 7 – San Diego and Imperial counties
  • Contra Costa, Placer and Sacramento PPO (rating region 3) will move to rating region 9
  • Yolo HMO and PPO (rating region 2) will move to rating region 9
  • Fresno (rating region 9) and Tulare (rating region 1) HMO will move to rating region 7 – San Diego
  • Santa Cruz Silver Network (once created) rates will be discounted 25% off the full network

SIC 10% Discount

Industry Description SIC Code
Furniture 2500 -2599
Stone, Clay, Glass 3200 – 3299
Steel, Metal Work 3300 – 3399
Industry Machine (Computer Related) 3500 – 3599
Electronic 3600 – 3699
Measurement Instruments 3800 – 3899
Wholesale Durable Goods 5000 – 5099
Banks 6000 – 6099
Real Estate 6500 – 6599
High Tech 7371 – 7379
Amusements & Recreation 7900 – 7999
Engineering & Other Professional Groups 8700 – 8799

 

 

 

 

 

 

  

 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

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.