The Ins and Outs of the EnhancedCare PPO Network

Brought to you by Health Net Life Insurance Company (Health Net)

Use the network You usually pay less when you use in-network providers than if you choose an out-of-network option. Your out-of-pocket costs are almost always higher when you use out-of-network providers.

To find an EnhancedCare PPO provider, go to www.myhealthnetca.com and click on Find a Doctor. Select 2018 as the plan year and enter your location. Then select PPO-EnhancedCare Individual & Family.

Individual & Family Plans

Your Health Net health insurance comes with a specific network of

doctors, hospitals, labs, and pharmacies called the EnhancedCare PPO

Network. When you go to EnhancedCare PPO providers for health care,

you’re staying “in-network.” When you go to other providers

who are not in the network, you’re going “out-of-network.”

Know where to go for immediate health careSometimes you need health care in a hurry. With EnhancedCare PPO, you have choices!

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Go to a retail clinic like a MinuteClinic (found in select CVS stores) to get care for many common illnesses or to get vaccinations.

Use Teladoc telehealth services by phone, mobile app or Web for a $0 copayment. Teladoc providers can treat many non-emergency common illnesses such as sinus problems, upper respiratory infections, allergies, bronchitis, and pinkeye. They can also write prescription refills for many medications.Choose an in-network urgent care center when

you need treatment right away for things like minor sprains, earaches, colds, or back pain.

5 ways to pay less

Be prepared for an emergencyGo directly to any hospital emergency room (ER) if you have an emergency.

Your EnhancedCare PPO insurance plan covers emergency care, even when the facility is out-of-network.

What’s important to know is that there are cost differences for ER care out-of-network.

See the next section, Understand how balance billing can cost you more, to understand the potential costs of out-of-network ER care.

Understand how balance billing can cost you moreUsually doctors, specialists, emergency rooms, and hospitals that are not in the EnhancedCare PPO network can bill you for any difference, or balance, between what they charge and what Health Net pays. The amount we pay – the allowed amount – is set by the plan benefits you have.

Balance billing amounts are not covered by your health plan. That means any bills from the doctor or hospital are in addition to your copayment and monthly premium. It also does not count toward your annual deductible or out-of-pocket maximum.

Example: Let’s say Joe sees a specialist outside the network. The charge is $1,500 and the Health Net allowed amount is $700. Joe may get a bill to pay the remaining $800. With more expensive care, like an ER visit, Joe’s costs could be thousands of dollars.

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Tip: Put the addresses for the closest in-network MinuteClinic, urgent care center and ER in your phone so you always have them. You can use our online

search tool, Find a Doctor, at myhealthnetca.com to find the nearest locations.

Tip: If your doctor refers you to a specialist or for tests, ask your doctor to select a provider in the

EnhancedCare PPO Network. That way, you’ll avoid getting a balance bill.

Know your plan’s cost rangesEnhancedCare PPO gives you choices of how and where you get care, so you have more control over what you pay.

Here’s a general guide to the cost range for the different ways you can get care:

Teladoc virtual doctor visit

Walk-in retail clinic

Doctor visit Urgent care Emergency room

In-network $0 $ $ $ $$

Out-of-network Not available Not available $$ $$$ $$$$$

We’re here for you!

Call your Health Benefit Navigator

team when you have questions

about using the provider network or

anything about your EnhancedCare

PPO insurance plan. The team is here

for you at 1-844-463-8188 (TTY: 711),

Monday through Friday, 8:00 a.m. to

5:00 p.m.

We are your Health Net.TM

Health Net EnhancedCare PPO insurance plans, Policy Form #P35001, are underwritten by Health Net Life Insurance Company. Health Net Life Insurance Company is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved.

FLY016664EL00 (11/17)

Health Net Life Insurance Company (Health Net) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Health Net does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Health Net:• Provides free aids and services to people with disabilities to communicate effectively with us,

such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats, other formats).

• Provides free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages.

If you need these services, contact Health Net’s Customer Contact Center at:

On Exchange/Covered California 1-888-926-4988 (TTY: 711)Off Exchange 1-800-839-2172 (TTY: 711)

If you believe that Health Net has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by calling the number above and telling them you need help filing a grievance; Health Net’s Customer Contact Center is available to help you. You can also file a grievance by mail, fax or online at:

Health Net Life Insurance Company PO Box 10348 Van Nuys, CA 91410-0348

Fax: 1-877-831-6019 Online: healthnet.com

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019 (TDD: 1-800-537-7697).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Nondiscrimination Notice

Health Net Life Insurance Company is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved.