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CALIFORNIA FARM BUREAU MEMBERS HEALTH INSURANCE PLANS
A GUIDE TO ALLYOUR HEALTHINSURANCE OPTIONS
Medical Dental Vision Supplemental term lie insurance Supplemental medical expense coverage
Eective January 1, 2011Exclusively or Farm Bureau members
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Get a quote online here
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11no-cost extras
DECISION POwER: HEALTH IN bALANCE 11
SEL-SERvICE AT www.HEALTHNET.COm 12
ARm bUREAU mEmbERSHIP DISCOUNT PROGRAmS 12
13getting started
STEP 1: CHECk ELIGIbILITY 13
STEP 2: CHOOSE A HEALTH PLAN 13
STEP 3: SEND YOUR APPLICATION 13
COmmON qUESTIONS 14
15major medical expense coverage
outline of coverage
READ YOUR CERTIICATE CAREULLY 15
mAjOR mEDICAL ExPENSE COvERAGE 15
PRINCIPAL bENEITS AND COvERAGES 15
ExCLUSIONS AND LImITATIONS 16
PRE-ExISTING CONDITIONS OR AGES 19 AND OLDER 18
RENEwAbILITY O THIS CERTIICATE 18
PREmIUmS 18
LOSS RATIO 19
SUPPLEmENTAL TERm LIE INSURANCE ExCLUSIONS 19
TERmINATION O SUPPLEmENTAL TERm LIE INSURANCE 19
HEALTH NET vISION AND DENTAL ExCLUSIONS & LImITATIONS
CONTENTS
2011 HEALTH NET
HEALTH INSURANCE PLANS AND OTHER HEALTH PRODUCTSOR THE CALIORNIA ARm bUREAU mEmbERS HEALTH INSURANCE PROGRAm
2california farm bureau federation
and health net
PROTECTING CALIORNIA AGRICULTURE
PROTECTING YOUR HEALTH 2
HELPUL DEINITIONS 3
4choosing the plan that fits your life
Cb SENSIbLE HSA NG 4
Cb bUDGET PPO NG 5
bENEITS AT-A-GLANCE 5
SUmmARY O bENEITS 67
8dental and vision
DENTAL 8
DENTAL SUmmARY O bENEITS AND RATES 8
vISION 9
vISION SUmmARY O bENEITS AND RATES 9
10rounding out your coverage
THE CASHNET PLAN 10
SUPPLEmENTAL TERm LIE INSURANCE 10
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2
Caliornia FarmBureau Federationand Health NetProtecting Caliornia agriculture,protecting your healthFor more than 75 years, the Caliornia Farm Bureau
Federation (CFBF) has protected and promoted
agricultural interests throughout Caliornia. Today,
anyone can join the Farm Bureau and benet rom
local county Farm Bureau representation and exclusive
membership oers like aordable health insurance.
When you join the Farm Bureau, youre eligible or an
exclusive line o Health Net insurance plans. Here at
Health Net weve designed a line o economical plans
to give you what you need most right now rate relie.
Whats more, our Caliornia Farm Bureau plans come
with extra resources and services to help you make the
most o your health. Its a combination that has made
us the choice o so many Caliornians. Among the
reasons that make Health Net a better decision:
1. We know Caliornia.Headquartered in Caliornia, Health Net has
been giving Caliornians access to broad networks,
personal service and useul wellness resources or
over 28 years, so they can manage their health the
way they want.
2. We have broad networks or more choice.Approximately 61,000 doctors, over 300 hospitals
and over 4,300 retail chain and independent
pharmacies give you the choices you deserve.And with such large provider networks, theres
a good chance your doctor is part o ours. Plus,
our worldwide emergency coverage protects you
wherever you travel.
Economical solutions one more
way Health Net is hard at work
to make protecting your health.
www.HealthNetworkInsurance.com
3. We save you time.Online tools. People to talk with on the phone.
With a Health Net plan, its easy to get answers
and to get things done.
4. Were ocused on quality.
Ongoing service monitoring helps ensure the careyou receive is the right care or you. Plus, you
can assess network quality or yoursel with the
provider and hospital comparison reports that we
make available online at www.healthnet.com.
5. We ll be here when you need us.Health Net Lie Insurance Company is backed
by Health Net, Inc., one o the nations largest
publicly traded managed health care companies,
with more than 6.6 million customers in the U.S.
Financially sound, the companys health plan and
insurance subsidiaries provide health and mental
health benets to millions o individuals. In times
like these, its good to know that your health plan
is aliated with a strong, national company.
Plus, Farm Bureau members get great discounts on
brand-name products and valuable resources to help
you make the most o your health. See No-Cost
Extras, starting on page 11, or details.
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HELPFUL dEFINITIONS
In this guide, youll see ords used that are specic to health care. wee dened the here to ae eerything
ast to read and easy to understand.
2) threatens the patients lie, or, i let untreated, ill
cause urther serious ipairent to the patients
odily unction.
Out-of-pocket maximum The aount o coered
charges that you ust pay in addition to applicale
copays and deductiles.
when you see the ter out-o-pocet aiu,
it eans the dollar liit o your share o health
care epenses.
PPO The Preerred Proider Organization
designated y us and/or any other health care
proider contracting organization that has
contracted ith Health Net.
Up-front coverage Up-ront coerage eans
that you can use certain serices eore you
eet your deductile. You ust pay a set
copay at the doctors oce. Also called rst
dollar coerage.
Applicant-onl plan Coers one person on a
Certicate o Insurance. multiple aily eers
can apply using the sae enrollent or. Single
rates apply to each aily eer. SeparateCerticates o Insurance ill e issued once the
application is approed.
Coinsurance The percentage o costs you pay
or coered serices, usually ater you eet your
deductile. These aounts ary y health plan.
Copa The dollar aount that a coered person is
reuired to pay or certain enets in addition to any
applicale coinsurance and/or deductile payents.
deuctible The aount o coered charges or hich
a coered person or aily unit has to incur and pay
each calendar year eore enets are payale. Certain
serices are aailale eore the deductile is et.
Emergenc An illness or accidental inury that:
1) reuires iediate care or edical interention;
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Youhavecompletecontroloveryourhealthcare
dollars and can use them when you like.
Whenusedforqualiedmedicalorpharmacy
expenses, contributions (up to the IRS maximum)
and withdrawals are tax-ree.
Long-termsavings,rolloverfeatures(notimelimit
or using the unds) and catch-up contributions
or members between the ages o 55 to 65.
Bonus Option! Health Net has partnered with Bank
o America to oer our members an HSA thats easy
to administer, quick to set up, and that comes with
a convenient Bank o America VISA debit card or
account access.
CFB Sensible HSANG the plan that makes sensein a challenging economy.
Reerences are to ederal taxes only. State taxes may apply. Taxinormation is or general purposes only. For more detailedinormation about the tax implications o an HSA, please contacta proessional tax adviser. A complete list o qualifed medicalexpenses can be ound in IRS publication 502 Medical andDental Expenses, at www.irs.gov.
The HSA component o EZ Access HSA is oered by Bank oAmerica, N.A., as trustee o the HSA. Health Net is not afliatedwith Bank o America, N.A.
Choosing the planthat ts your lieHealth Net oers Farm Bureau members a selection
o PPO health insurance plans so you can nd thehealth plan that ts your budget and your lie. These
plans are underwritten by Health Net Lie Insurance
Company.
PPOplansgiveyoufreedomofchoice.Youcango
to a doctor or hospital in our PPO network or the
highest benet coverage there are approximately
61,000 providers and over 300 hospitals statewide to
choose rom or you can see a provider not in our
network and pay a greater share o the costs.
Child and children-only coverage is available or all o
our plans.
CFB SenSiBle HSAnG
Our Health Savings Account (HSA)-eligible PPO
insurance plan makes it possible to take advantage o
tax-savings opportunities while you protect your health.
$5,200calendar-yeardeductible.Forfamily
coverage, the calendar year deductible is two-times
the individual amount.
100%ofin-networkcoverageforcoveredbenets
ater your calendar year deductible is met.
100%ofin-networkcoverageforadultandchild
preventive care (deductible waived).
Ater you enroll, you can open an HSA. When you
have an HSA, you can use tax-ree dollars to pay or
plan deductibles, copays and other qualied medical
expenses. The HSA belongs to you; you keep it even iyou change jobs or retire. Other key acts about HSAs:
Youcancontributeupto$3,050toyourHSA
asanindividualor$6,150ifyouhavefamily
coverage. These are the 2011 maximum
allowable amounts as set by the IRS.
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5
BeneFitS At-A-GlAnCe
This chart is a summary o in-network benets only and not intended or enrollment purposes. For benet
details, please see the Summary o Benets.
1Deductile aied or rst 2 isits.
CFB BudGet PPO nG
The CFB Budget PPO NG insurance plans pair
reedom and fexibility with lower monthly premiums.
Twocalendaryeardeductiblechoicesgiveyou
fexibility in nding the premium/deductible
combination that ts your budget best.
Individualdeductibles:$6,000or$7,500
Applicant-onlycoverage
Youcanseethedoctor(upto2visits)fora$50copay
(deductible waived).
100%in-networkcoverageforadultandchild
preventive care (deductible waived).
Three-tierandspecialtyprescriptiondrugcoverage.
Forallotherservices,thisplanpays100%of
in-network coverage or covered benets ater your
calendar year deductible is met.
CFB Budget PPO NGs the solution or essential
health coverage at a reasonable cost.
LIFETIME MAXIMUM: Unliited CFB SENSIBLE HSA NG CFB BUdGET PPO NGApplicant-Only Plan
CALENdAR yEAR dEdUCTIBLES $5,200 single(aily deductile is 2 the indiidual)
$6,000 or $7,500
CALENdAR yEAR OUT-OF-POCKETMAXIMUM
$5,200(includes deductile) (2 or aily)
$0
VISIT TO PHySICIAN No charge ater deductile is et $50 copay per isit1
X-RAy ANd LABORATORy No charge a ter deductile is et No charge a ter deductile is et
MATERNITy CARE Not coered Not coered
PREVENTIVE CARE SERVICES
(ault an chil)
No charge (deductile aied) No charge (deductile aied)
EMERGENCy HEALTH COVERAGE No charge a ter deductile is et No charge a ter deductile is et
OUTPATIENT SERVICES No charge a ter deductile is et No charge a ter deductile is et
OUTPATIENT FACILITy SERVICES No charge a ter deductile is et No charge a ter deductile is et
HOSPITALIZATION SERVICES No charge a ter deductile is et No charge a ter deductile is et
OUTPATIENT PRESCRIPTION dRUGS No charge a ter deductile is et $500 calendar year deductile per person(does not apply to Leel I)
Level I (generic) $10 copayLevel II (orulary rand) $50 copayLevel III (non-orulary rand) 50% or$50 copay (hicheer is greater)Specialt drugs (sel-inectales) 50% or$500 copay (hicheer is less)
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Summary o benetsReer to your Certicate o Insurance or coplete details, eclusions and liitations. In ca se oconfict, the Certi cate o Insurance controls. benets suect to deductile unless noted.
1 Eedded deductile eans one person on a plan it h 2+ eers can eet the indiidual deduc tile and egin receiing coered enets.2 Certain serices ay reuire prior certication ro Health Net. without prior certication, enet is reduced y 50%. Reer to the Certicate o Insurance or details.3 Coered serices ased on the United States Preentie Serice s Tas orce (USPST) grade A and b recoendations; recoendations o the Adisory Coit te
on Iunization Practices (ACIP) t hat hae een adopted y the Director o the Centers or Disease Control and Preention (CDC); and coprehensie guidelinessupported y the Health Resources and Serices Adinistration (HRSA) or inants, children and adolescents.
4 Inpatient is $300 aiu alloale per day. Outpatient aiu payale is $3 0 per isit only applies to Cb Sensile HSA NG.5 The Recoended Drug List is a lis t o prescription drugs that are coered y this plan. Soe drugs reuire prior authorization ro Health Net.
or a copy o the Recoended Drug List, go to .healthnet.co. Reer to a Certicate o Insurance or coplete inoration on prescription drugs.
6
LIFETIME MAXIMUM:Unliited
CFB SENSIBLE HSA NG
IN-NETWORK YOU PAY OUT-OF-NETWORK YOU PAY
CALENdAR yEAR dEdUCTIBLESNot included in calendar year out-o-pocet aiu, ecept on Cb Sensile HSA NG.aily deductile is 2 the single deductile.
$5,200 single(All enets, including outpatient prescription drugs, are suect to the deducti
ecept preentie care. or contracts o to or ore eers, there is an eeddindiidual deductile1.)
CALENdAR yEAR OUT-OF-POCKET MAXIMUMDoes not include calendar year deductile, ecept on in-netor Cb Sensile HSA NG.Payents or serices not coered y this plan ill not apply to this calendar yearout-o-pocet aiu. Copays do not apply to calendar year out-o-pocetaiu, ecept on Cb Sensile HSA NG.
$5,200 single(aily is 2 single)
$5,000 single(aily is 2 single)
PROFESSIONAL SERVICESvisit to physician (including specialist consultations)
No charge ater deductile is et
50%
x-ray and laoratory procedures2 No charge ater deductile is et 50%
Surgeon or assistant surgeon and anesthetic serice No charge ater deductile is et 50%
PREVENTIVE CARE SERVICES (ault an chil)Routine preentie serices and iunizations3
No charge (deductile aied) Not coered
EMERGENCy HEALTH COVERAGEEergency roo (proessional and acility charges)
No charge ater deductile is et
Urgent care center (acility charges) No charge ater deductile is et
Aulance No charge ater deductile is et
OUTPATIENT SERVICES2
Outpatient surgery (hospital or outpatient surgery center charges only).Out-o-netor aiu alloale charge is $600 per day.
No charge ater deductile is et
50%
Outpatient acility serices2 No charge ater deductile is et 50%
HOSPITALIZATION SERVICES2
Inpatient, sei-priate hospital roo or intensie care unit ith ancillary serices(unliited, ecept or non-seere ental health and sustance ause treatent).Out-o-netor aiu alloale charge is $600 per day.
No charge ater deductile is et
50%
MATERNITy CARE Not coered
OTHER SERVICESRehailitatie therapy (includes physical, speech, occupational, respiratory andcardiac therapy) Outpatient: 20-isit aiu per calendar year coined in- orout-o-netor.
No charge ater deductile is et 50%
Chiropractic care / Acupuncture(12-isit aiu per calendar year coined in- or out-o-netor)
No charge ater deductile is et 50%
mental health or non-seere conditions2,4 No charge ater deductile is et(inpatient and outpatient)
Inpatient: 50%Outpatient: Not coered
Diaetic euipent No charge ater deductile is et Not coered
Durale edical euipent ($2,0 00 aiu payale per calendar year) No charge a ter deduc tile is et Not coered
OUTPATIENT PRESCRIPTION dRUGS5
Prescription drugs lled through participating pharacy (up to a 30-day supply).
Prescription drugs lled through participating ail order (up to a 90-day supply).
medical deductile aied on the Cb budget PPO NG plan.Does not count toards
your calendar year out-o-pocet aiu, ecept on Cb Sensile HSA NG.
No charge ater deductile is et Not coered
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7
CFB BUdGET PPO NGApplicant-Only Plan
IN-NETWORK YOU PAY OUT-OF-NETWORK YOU PAY
$6,000 or $7,500
$0 $6,000
$50 copay per isit (deductile aied orrst 2 isits)
50%
No charge ater deductile is et 50%
No charge ater deductile is et 50%
No charge (deductile aied) Not coered
No charge ater deductile is et
No charge ater deductile is et
No charge ater deductile is et
No charge ater deductile is et
50%
No charge ater deductile is et 50%
No charge ater deductile is et
50%
Not coered
Inpatient: No charge ater deductile is etOutpatient: Not coered
Inpatient: 50%Outpatient: Not coered
Not coered
Inpatient: No charge ater deductile is etOutpatient: Not coered
Inpatient: 50%Outpatient: Not coered
No charge a ter deduc tile is et Not coered
No charge a ter deduc tile is et Not coered
$500 calendar year deductile per person(does not apply to Leel I)
Level I (generic) $10 copayLevel II (orulary rand) $50 copayLevel III (non-orulary rand) 50% or
$50 copay (hicheer is greater)Specialt drugs (sel-inectales) 50%or $500 copay (hicheer is less)
Not coered
Good health means something
dierent to everyone. How youprotect yours is an individual
choice. Come to Health Net or
health insurance coverage that
fts your health, your lie and
your budget. Apply online atwww.HealthjNetworkInsurance.com
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Dental and VisionWhen you choose a Health Net PPO insurance plan, you have
the option to add on dental and/or vision coverage.
dentAl
Health Net helps you keep your teeth healthy with two dental
plan choices:
TheHealthNetDentalScheduledReimbursementPlan
provides reimbursement at a set rate or dental services
provided by the dentist o your choice.
TheHealthNetDentalHMOplancoversdentalservicesthat
you receive rom a primary HMO dentist in our network.
Youcanchooseaparticipatingofcefromalistofnetwork
providers in your area. To nd a dental HMO provider:
8
The chart on the let is a suary o the enets. or oreinoration, please reer to the Schedule o benets, Eclusionsand Liitations or Health Nets Dental Plans hich can edonloaded ro Health Nets esite at .healthnet.co.
1You ust select a dental HmO netor proider or serices.Procedures perored y a non-netor dentist are not
coered and enrollees are reuired to pay all charges.2maor restorations hae a 12-onth aiting period orthe Scheduled Reiurseent Plan. benets are suectto change.
3benets coer 24 onths o Usual and Custoary (U&C) and24 onths o retention.
USUAL AND CUSTOmARY (U&C) eans charges or dentalserices or supplies essential to the care o the Insured i they arethe aount norally charged y the proider or siilar sericesand supplies and do not eceed the aount ordinarily chargedy ost proiders o coparale serices and supplies in thelocality here the serices or supplies are receied.
HMO1 (You pay) SCHEdULEdREIMBURSEMENTPLAN2 (Plan pays up to)
MAXIMUM CALENdAR Unliited $1,000yEAR BENEFIT
CALENdAR yEAR dEdUCTIBLE $0 $50 per person
dIAGNOSTICOral eaination (up to 2 per year) $0 $24
Intraoral radiographs $0 (Including $62 (Includingiteings eery 3 yrs) iteings eery 5 yrs)
PREVENTIVEProphylais (2 cleanings;once eery 6 onths)
Adult $0 $40
Child (through age 18) $0 $28
Sealant (per peranent olar tooth) $5 (through age 15) $26 (through age 17)
RESTORATIVEAalga (peranent llings)
One surace $0 $38
To suraces $0 $48
Cron2 (porcelain/ceraic) $245 $220
PROSTHETICS/PROSTHOdONTICS2
Denture (coplete upper or loer) $325 each $315
ENdOdONTICSRoot canal (ecluding nal restorations)Anterior $110 $193
molar $265 $306
ORAL SURGERy (extractions)Single tooth $5 $39
Reoal o ipacted tooth $80 $134(copletely ony)
ORTHOdONTICSChildren (through age 19) 75% o U&C3 Not coered
Adult 75% o U&C3 Not coered
monthly rates eectie 7/1/08. Rates suect to change.
HMO SCHEdULEdREIMBURSEMENTPLAN
MEMBER $20.00 $39.00
MEMBER +1 $38.00 $78.01
MEMBER +2 OR MORE $58.00 $111.16
Go to www.healthnet.com.
Select Find a Doctor or Hospital.
Select Find providers by city, county, state or ZIP,
then select I Agree.
Select State.
Select the box or Dental (Dentists, DentalHygenists, etc.) then Search.
Select Commercial Health Plans Optum.
This will redirect you to a new page showing a
disclaimer. Please read and clickContinue. This will
take you to Health Net Dental plans.
Select Locate Dentistlink rom the let
navigation bar.
Select DHMO CA ONLY.
Select the appropriate search criteria, then key
in the Search Fields and select Submit.
Choose your dentist and include the Practice
ID# in the specied area on the application.
Please note: The Health Net Dental HMO plan is
not available in all counties. Please see the Monthly
Premium Rate Guide or details.
dentAl SummAry OF BeneFitS And rAteS
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Aitional Purchases anOut-of-Pocket discounts
meer ill receie a 20% discount on itesnot coered y the plan at ParticipatingProiders. The discount does not apply tocontracted proiders proessional serices ordisposale contact lenses. benets ay note coined ith any discount, prootionaloering, or other group enet plans.Alloances are one-tie use enets; noreaining alance. Lost or roen aterialsare not coered.
The Health Net vision Secondary Purchaseplan proides up to a 40% discount o
coplete pair o eyeglass purchases and a15% discount o conentional contact lensesonce the initial enet has een used.
ViSiOn SummAry OF BeneFitS And rAteS
monthly rates eectie 1/1/06. Rates suect to change.
PPO VISION PLAN
MEMBER $13.66
MEMBER +1 $26.65
MEMBER +2 OR MORE $38.25
MEMBER COST OUT-OF-NETWORK
REIMBURSEMENT
EXAM WITH dILATION AS NECESSARy $10 copay $45
CONTACT LENS FIT ANd FOLLOW-UP(Contact lens t and to ollo-up isits areaailale once a coprehensie eye-ea haseen copleted.)
Standard $0 copay / it and to $40ollo-up isits paid in ull
Preiu $0 copay / 10% o retail price, $40then apply $55 alloance
FRAMESAny aailale rae at proider location $0 copay / $85 alloance $45
or any rae plus 20%o alance oer $85
STANdARd PLASTIC LENSESSingle ision $0 copay $43
biocal $0 copay $58
Triocal $0 copay $70
Lenticular $0 copay $125
LENS OPTIONSUv coating 20% discount Not coered
Tint (solid and gradient) 20% discount Not coered
Standard scratch-resistance 20% discount Not coered
Standard polycaronate 20% discount Not coered
Standard progressie (add-on to iocal) 20% discount Not coered
Standard anti-refectie 20% discount Not coered
Other add-ons and serices 20% discount Not coered
CONTACT LENSES(includes aterials only)
Conentional $0 copay / 15% discount $105o alance oer $120
Disposales $0 copay / balance oer $120 $105
medically neces sary $0 copay $210LASER VISION CORRECTIONLASIk or PRk ro U.S. Laser Netor 15% o retail price, or Not coered
5% o prootional price
FREQUENCyEaination Once eery 12 onths
rae Once eery 24 onths
Lenses or contact lenses Once eery 24 onths
9
ViSiOn
Our fexible and aordable PPO vision program will keep
you seeing clearly.
Youchoosewheretogoatthetimeofservicenoneed
to select a vision provider when you enroll. Note that
you pay less when you see an in-network vision provider.
Highstandardsofqualityandservice.
Completevisualexaminationevery12months
($10copaymentapplies).
Framesoneframeevery24months(maximum
allowance$85in-network,upto$45out-of-
network).
For more details, please reer to Health Nets PPO
Vision Plan schedule.
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10
Age $10,000 $20,000 $30,000 $40,000 $50,000
117 $1.00 N/A N/A N/A N/A
1829 $1.90 $3.80 $5.70 $7.60 $9.50
3039 $2.40 $4.80 $7.20 $9.60 $12.00
4049 $5.00 $10.00 $15.00 $20.00 $25.00
5059 $13.70 $27.40 $41.10 $54.80 $68.50
6064 $20.00 $40.00 $60.00 $80.00 $100.00
Individual Term Lie Insurance Coverage Amounts
monthly rates eec tie 7/1/08. Rates suect to change.
Rounding outyour coverageRound out your health coverage with optional
products that deliver added nancial protection.
tHe CASHnet PlAn
CashNet is a supplemental medical expense plan that
helps bridge the cost o hospitalization, surgery or an
accident. For a modest monthly premium, you get
cash reimbursements which are paid directly to
you when you need them or:
Hospital stays
$300perdayforhospitalcoveredchargesforall
illnesses and accidental injuries.
Maximumof30dayspercalendaryear.Lifetime
maximum o 300 days.
Accidental injury:Uptoamaximumof$500peryear. Not applicable to Child(ren)-only policies.
Ambulancetransportation due to an accident:
$300forlandtransportation.
$1,000forairtransportation.
Not applicable to Child(ren)-only policies.
Mammography:Upto$100withamaximumo 1 visit per calendar year.
YoucansupplementanyHealthNethealthplan
with CashNet even our HSA-compatible CFB
Sensible HSANG plan.
Other important things to know:
TheCashNetPlanisasupplementtohealth
insurance, underwritten by Health Net Lie
Insurance Company. It is not a substitute or
hospital or medical expense insurance, a health
maintenance organization (HMO) contract or
major medical expense insurance.
PaymentofCashNetbenetsissubjecttoallother
terms o the policy. Please reer to the Certicate
o Insurance or a list o exclusions and limitations.
SuPPlementAl term liFe inSurAnCe
YoumayapplyforSupplementalTermLife
Insurance when you apply or your medical plan. Iyou are approved or health coverage, your term lie
coverage is also approved.
Health Net oers Supplemental Term Lie
Insurance, underwritten by Health Net Lie
Insurance Company, or adults (up to age 64) in
coverageamountsof$10,000,$20,000,$30,000,
$40,000and$50,000.Themaximumcoverage
amountforchildrenages117is$10,000.
Simply complete the Supplemental Term Lieportion o the application. Premium is billed
separately rom your health insurance.
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No-cost extrasdeCiSiOn POwer: HeAltH in BAlAnCe
Inormation, resources and support or every person,every stage o health
With Health Net, you get more than health care coverage.
YougetDecisionPower1. Decision Power brings together
under one roo the inormation, resources and personal
support that t you, your health and your lie.
Whether you
haveaquestion
wanthelpwithaspecichealthgoal
needtreatmentbutwanttounderstandallyouroptions
arelivingwithillness you choose how and when to use the inormation,
resourcesandsupportavailable.YoucanuseDecision
Power online. Or by calling a Health Coach. Try multiple
resources at once, or one at a time. 24 hours a day, seven
days-a-week, Decision Power is here or you.
Log on to www.healthnet.com:
Take the health risk questionnaire (HRQ) With its
instant results and interactive eatures, the HRQ is your
gateway to recommendations and resources based on yourunique health prole. Among the highlights: youll receive
email alerts on inormation and action steps to take based
on your HRQ results.
Try a step-by-step plan or losing weight, stopping
smokingorboostingnutrition.Youcanstartwithour
online coaching and sel-help tools. Phone coaching support
is included, so making lasting, healthy changes is easier.
Track your health progress and build a complete medical
snapshot to have whenever you need it with a Personal
Health Record.
Find supportor any kind o mental health concern such
as depression, alcohol use, eating disorders, etc.
Be informed Access inormation resources, such
as Healthwise Knowledgebase, an online health
encyclopedia; HEAR Audio Library, which contains
inormation on 355 health topics; and Health
Crossroads Web Modules, which explains the pros
and cons o various treatments.
Know your numbers with our health trackers
(cholesterol, diet, tness), treatment cost estimator and
hospital comparison reports.
Talk to a Health Coach to get:1-to-1 consultations and a single point o contact or
anyandeveryhealthquestion,goalorsituation.Youcan
talk to the same Health Coach every time you call.
Steps to avoid Cardio-Metabolic Syndrome the
combination o three or more o the six risk actors
(e.g., waist size, blood pressure, HDL cholesterol level)
that predict diabetes, heart disease and colon, uterine
and prostate cancers.
24-hour answers to health questions or concerns.Always call 9-1-1 or go straight to the emergency room
in a lie-threatening situation.
Techniques to help you eel comortable talking with
your doctor and expressing your preerences.
Pointers or setting achievable health goals; guidance
on evaluating treatment options.
Guidance and supportor living with an ongoing
illness such as asthma, diabetes, heart disease, etc.
Specialized consultation rom nurse case managers to
help both patients and amily members deal with the
complexity o end-stage illnesses.
YoucanuseDecisionPowerwheneveryouwantand
as much as you like. Because when it comes to your
health, theres more than one right answer.
24-hour answers to health
questions or concerns.
1 Decision Power is not part o Health Nets commercial medica l benet plans.
Also, it is not aliated with Health Nets provider network and it may berevised or withdrawn without notice.
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SelF-SerViCe At www.HeAltHnet.COm
At www.healthnet.com we make it ast and easy to
get things done on your schedule. Once youre a
Health Net member, it will take only a minute to
register online. With your user name and password,
you can:
OrderIDcards.
Seeyourplandetails.
Viewpharmacybenets.
SearchforaphysicianorspecialistinCalifornia.
Comparemedicalgroupandhospitalqualityand
service ratings.
Findapharmacistnearyou.
Getforms.
EmailtheCustomerContactCenter.
Useourinteractivetools.
Learnabouthealthconditions.
Andmuchmore!
FArm BureAu memBerSHiP
diSCOunt PrOGrAmS
In addition to all the Health Net no-cost extras,
Farm Bureau members have access to many exclusive
products and discount programs. Enjoy smart, new
ways to save hundreds o dollars a year.
20%eyeweardiscountLensCrafters
FarmBureauPrescriptionDiscountProgram
Upto30%discountonpaintandsupplies
Kelly-Moore and Dunn Edwards Paint
10%offGraingercommercialandhomeimprovement products ree shipping or online
orders
RentalcardiscountsAvis,HertzandBudget
Traveldiscounts
DodgeandRAMtrucksrebate
Themeparkdiscounts
7.5%discountonautoinsuranceAlliedand
Nationwide Insurance
FarmBureauBankfullrangeofnancialservices
10%discountonLandsEndproductsandlogofees
Upto25%offStarkeyHearingAidsandhearing
products, plus signicant savings on other hearing
health care needs through ClearValue Hearing
Healthcare Benets Plan
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Getting startedSteP 1: CHeCk eliGiBility
There are our requirements to meet:
Forsixcontinuousmonthsorlonger,beaCaliornia resident under age 65 who is not
eligible or Medicare.
Meetourmedicalunderwritingguidelines.All
applicants are subject to medical underwriting to
determine medical risk. Based on the results o the
medical underwriting, one or more o the ollowing
may happen:
Coverage may be oered at the standard rate.
Coverage may be oered at a higher rate.
Coverage may be oered or a dierent plan
or deductible.
Coverage may not be oered.
BeorbecomeaCaliforniacountyFarm
Bureau member.
Betheapplicantsspouse,ortheapplicants
Caliornia-registered domestic partner, under
age 65, who is not eligible or Medicare.All dependent children under age 26 may apply or
dependent coverage, subject to medical underwriting
guidelines.
SPeCiAl OPen enrOllment FOr
CHildren under 19 yeArS OF AGe
There is an Open Enrollment period or children
under age 19. Please talk to your broker or contact
Health Net or more inormation.
SteP 2: CHOOSe A HeAltH PlAn
Reviewthebenetchartshownonpages67to
determine which plan best ts your needs.
For a premium quote, please call 800-569-1156.
Completeanapplication.Theapplicationmust
be completed and signed by the applicant. Be sure
to ll out the health application accurately and
completely. An incomplete application will delay
the process.
Yourapplicationrequiresthatyouremainamember o the Farm Bureau. I you are not
a member, please ll out the Farm Bureau
application.
Youhavethefollowingoptionsforpayingyour
annual Farm Bureau membership dues:
Submit your annual membership dues along
with your health premium and application.
Youwillreceiveannualbillingsdirectlyfrom
the Farm Bureau or membership renewal.
YoucanpayyourFarmBureaumembership
dues monthly. It will be included with your
selectedmonthlypaymentmethod.A$2.00
monthly administrative ee will be included.
Youalsogettochoosethepaymentmethod
you preer or your monthly premiums. The
choices are:
Automatic bank drat (ABD): automatically
withdraws the premium rom your checking orsavings account (you choose which account).
Credit card: monthly, repetitive charge to your
VISA or MasterCard.
Monthly billing by mail.
SteP 3: Send yOur APPliCAtiOn
Send your completed and signed application, along
with the appropriate premium, to your Health Net
authorized agent or mail to the address listed on theapplication.Yourinitialpaymentcanbechargedto
your VISA or MasterCard as noted on the health
application.
Preer to apply online? Ask your Health Net
authorized agent about details or an online
application.
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14
COMMON QUESTIONS
What PPO octors an facilities can I use?
You hae access to the Health Net Lie netor,
one o Caliornias largest, ith approiately
61,000 PPO physicians and oer 300 hospitals.
To nd a proider:
1. Go to
2. Choose Find a Doctor or Hospitalro the
hoe page.
3. Search y Proider, near your address or y city,
county, state or ZIP.
4. Select plan PPO & PPO Plus to pull up the
netor that applies to ar bureau.
Can I appl for health coverage for mchilren onl?
Yes. All o our health insurance plans are aailale
or child/children-only coerage. Special children
rates are aailale.
Is it possible for m spouse to have aifferent plan from mine?
Sure. many couples nd that their indiidual healthcare needs ary and ant dierent coerage
aounts and deductiles. I you apply or dierent
plans/deductiles on one application, applicant-
only rates ill apply. Your authorized agent can tell
you ore.
Is preventive care covere?
Yes. Adult and child preentie care is a coered
enet. Please reer to the enet chart or
coerage inoration.
Is there a separate euctiblefor prescriptions?
I your plan includes the 3-tier prescription drug
enet, there is a separate $500 calendar year
deductile or Leel II, Leel III and Specialty
Drug tiers.
I you hae the Cb Sensile HSA NG plan, there
is no separate prescription deductile, hoeer,your edical plan deductile ust e et
eore any prescription enets are payale.
Wh o I nee a California
Farm Bureau membership?
These Health Net plans are only aailale
to ar bureau eers. The ar bureau
meers Group Health Progra has sered its
eers since 1947. Your annual eership in
a county ar bureau supports the agriculturalindustry in Caliornia. Plus you get eer
discounts on any aluale products and
serices including hotel, car rentals and ore.
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15
Health Net Lie Insurance CompanyCaliornia Farm Bureau MembersHealth Insurance PlansMajor Medical Expense CoverageOutline o Coverage
reAd yOur CertiFiCAte CAreFully
This outline o coverage provides a brie description
o the important eatures o your Certicate o
Insurance (Certicate). This is not the insurance
contract and only the actual Certicate provisionswill control. The Certicate itsel sets orth, in detail,
the rights and obligations o both you and Health Net
Lie Insurance Company. It is, thereore, important
that you read your Certicate careully!
mAjOr mediCAl exPenSe COVerAGe
This category o coverage is designed to provide, to
persons insured, benets or major hospital, medical
and surgical expenses incurred as a result o a covered
accident or sickness. Benets may be providedor daily hospital room and board, miscellaneous
hospital services, surgical services, anesthesia services,
in-hospital medical services, out o hospital care
and prosthetic appliances subject to any deductibles,
copayment provisions, or other limitations which may
be set orth in the Certicate. Basic hospital or basic
medical insurance coverage is not provided.
PrinCiPAl BeneFitS And COVerAGeS
Please reer to the pages 67 o this booklet or a
summary o each plans covered services and supplies.
Also reer to the Certicate you receive ater you
enroll in a plan. The Certicate oers more detailed
inormation on the benets and coverage included in
your health insurance plan.
Reproductive health services
Some hospitals and other providers
do not provide one or more o the
ollowing services that may becovered under your Certicate o
Insurance and that you or your
amily member might need: amily
planning; contraceptive services,
including emergency contraception;
sterilization, including tubal ligation
at the time o labor and delivery;
inertility treatments; or abortion.
Youshouldobtainmoreinformation
beore you enroll. Call your prospectivedoctor, medical group, independent
practice association or clinic, or call
Health Net Lies Customer Contact
Center at 1-800-839-2172 to ensure
that you can obtain the health care
services that you need.
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16
exCluSiOnS And limitAtiOnS
The ollowing is a partial list o services that are
not generally covered. For complete details on any
plans exclusions and limitations, please see the
Health Net Lie Caliornia Farm Bureau Members
Health Plan Certicate.
Servicesorsuppliesthatarenotmedicallynecessary.
Anyamountsinexcessofthemaximumamounts
specied in the Certicate.
Pregnancyormaternityservicesexceptasspecied
in the Certicate.
CosmeticsurgeryexceptasspeciedintheCerticate.
Contraceptivedrugsand/orcertaincontraceptive
devices are covered as specied in the Certicate.Vaginal contraceptive devices are only covered when
a Physician prescribes the device and perorms a
tting examination as specied in the Certicate.
DentalservicesexceptasspeciedintheCerticate.
TreatmentandservicesforTemporomandibular
(Jaw) Joint Disorders.
Surgeryandrelatedservicesforthepurposesof
correcting the malposition or improper development
o the bones o the upper or lower jaw, except whensuch procedures are Medically Necessary.
Foodordietary,nutritionalsupplements,except
or ormulas and special ood products to prevent
complications o Phenylketonuria (PKU).
Visioncareincludingcertaineyesurgeriestoreplace
glasses, except as specied in the Certicate.
Optometricservicesoreyeexercises,exceptas
specically stated elsewhere in the Certicate.
Eyeglassesorcontactlensesandeyeglasses,exceptas
specied in the Certicate.
Sexchanges.
Servicestoreversevoluntarysurgicallyinduced
inertility.
Servicesorsuppliesthatareintendedto
impregnate a woman are not covered.
Certaingenetictesting.
Experimentalorinvestigativeservices.
Routinephysicalexams,exceptforpreventive
care services (e.g., physical exam or insurance,
licensing, employment, school or camp). Any
physical, vision or hearing exams which are
not related to diagnosis or treatment o illness
or injury, except as specically stated in the
Certicate.
Immunizationsorinoculationsforadultsor
children, except as described in the Medical
Benets section or or oreign travel or
occupational purposes.
Servicesnotrelatedtoacoveredillnessorinjury.
Custodialordomiciliarycare.
Inpatientroomandboardchargesincurredin
connection or an admission to a Hospital or
other Inpatient treatment acility primarily or
diagnostic tests which could have been perormedsaely on an outpatient basis.
Inpatientroomandboardchargesinconnection
with a Hospital stay primarily or environmental
change, physical therapy or treatment o
chronic pain.
Anyservicesorsuppliesfurnishedbyanon-
eligible institution, which is other than a legally
operated Hospital or Medicare-approved Skilled
Nursing Facility, or which is primarily a place
or the aged, a nursing home or any similar
institution, regardless o how designated.
ExpensesinexcessofaHospitals(orother
Inpatient acilitys) most common semi-private
room rate.
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Infertilityservices.
Allergyserum.
Privatedutynursing.
Mentalandnervousdisorderandsubstanceabuse
treatment, except as specied in the Certicate.
Hyperkineticsyndromes,learningdisabilities,
behavioral problems or mental retardation.
However, certain o the above conditions shall be
covered as outlined in the Certicate. Over-the-countermedicalsuppliesandmedications.
Personalcomfortitems.
Orthotics,unlesscustommadetottheCovered
Persons body and as specied in the Certicate.
.Educationalservicesornutritionalcounseling,
except as specied in the Certicate.
Hearingaids.
Obesityrelatedservices.
AnyservicesreceivedbyMedicarebenetswithout
payment o additional premium.
Servicesreceivedbeforeyoureffectivedate
o coverage.
Servicesreceivedaftercoverageends.
Servicesforwhichnochargeismadetothe
Covered Person in the absence o insurance
coverage, except services received at a charitable
research Hospital which is not operated by a
governmental agency.
Physicianself-treatment.
Servicesprovidedbyimmediatefamilymembers.
ConditionscausedbytheCoveredPersonscommission (or attempted commission) o a elony
unless the condition was an injury resulting rom
an act o domestic violence or an injury resulting
rom a medical condition.
Conditionscausedbyreleaseofnuclearenergy,
when government unds are available.
Anyservicesprovidedby,orforwhichpayment
is made by, a local, state or ederal government
agency. This limitation does not apply to Medi-
Cal, Medicaid or Medicare.
Servicesforconditionsofpregnancyforasurrogate
parent are covered, but when compensation is
obtained or the surrogacy, we shall have a lien on
such compensation to recover its medical expense.
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Anyoutpatientdrugs,medicationsorother
substances dispensed or administered in any
outpatient setting except as stated in the Certicate.
Sexualdysfunctiondrugs.
Rehabilitativeservicesrenderedinanoutpatient
acility are not covered except as specied in
the Certicate.
Rehabilitationtherapyservicesarenotcoveredwhen
provided in connection with the treatment o the
ollowing conditions:
Psychosocial speech delay (includes delayed
language development)
Mental retardation or dyslexia
Attention decit disorders and associatedbehavior problems
Developmental articulation and language
disorders
However, some o the above conditions shall be
covered as shown in the Schedule o Benets
section, i Medically Necessary as described in the
denitions o Serious Emotional Disturbances
o a Child and/or Severe Mental Illness, and
continuous unctional improvement in response to thetreatment plan is demonstrated by objective evidence.
Outpatientspeechtherapy,exceptasspeciedinthe
Certicate.
Servicesandsuppliesobtainedwhileinaforeign
country with the exception o Emergency Care.
Homebirth.
Some services require pre-certication rom
Health Net prior to receiving services. Please reer
to your Certicate or details on what services and
procedures require pre-certication.
Health Net Lie does not require pre-certication
or dialysis services or maternity care. However,
please call the Customer Contact Center at 1-800-
839-2172 upon initiation o dialysis services or at
the time o the rst prenatal visit.
Pre-exiStinG COnditiOnS FOr AGeS 19
And Older
Covered services will not include any care required
in connection with the treatment o any condition,
disease or injury or which medical advice, diagnosis,
care or treatment, including the use o prescription
medications, was recommended by or received rom
a licensed health care practitioner during the six
months immediately preceding the eective date o
coverage under the Certicate. Credit will be given
toward the pre-existing condition waiting period or
membership with another creditable health care plan
i you apply or coverage under Health Net Lies
Caliornia Farm Bureau Members Health Insurance
Program plans within 62 days o termination with
the previous plan.
renewABility OF tHiS CertiFiCAte
Subject to the termination provisions described in
the Certicate, coverage will remain in eect or
each month premium ees are received and accepted
by Health Net Lie. Coverage will terminate i the
group Policy issued to the Caliornia Farm Bureau
Federation by Health Net Lie is cancelled.
PremiumS
We may adjust or change your premium. I we
change your premium amount, notice will be mailed
to you at least 60 days prior to the premium change
eective date. Premiums are automatically adjusted
or changes in your and your dependent spouses or
registered domestic partners ages. Premiums may be
adjusted when your residence address changes.
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lOSS rAtiO
Health Net Lies 2009 ratio o incurred claims to
earned premiums or the Caliornia Farm Bureau
Federation Plans is 78.2 percent.
SuPPlementAl term liFe
inSurAnCe exCluSiOnS
No benets will be provided on the death o any
Covered Person under the ollowing circumstances: Deathbysuicidewithintwoyearsfromthe
eective date o Coverage. Our liability shall be
limited to an amount equal to the premiums paid.
Deathbyanyactofwar,declaredorundeclared.
terminAtiOn OF SuPPlementAl term
liFe inSurAnCe
Coverage under this Certicate or a Covered Person
will end on the earliest o the ollowing dates: ThedatetheGroupPolicyends;
Thelastdayoftheperiodforwhichpremiumhas
been paid (subject to the grace period provision);
Thelastdayofthecalendarmonthinwhich:
(a) the Covered Person dies; (b) the Member
ceases to be a member o one o the County Farm
Bureaus comprising the Caliornia Farm Bureau
Federation; (c) the Covered Person becomes
insured under any other Caliornia Farm Bureau
Federation service to member health insurance
program as a member; (d) written notice,
signed by the Member, is received, requesting
termination o coverage or any or all Covered
persons; (e) a Covered person enters active
military service; or () the Covered persons health
coverage under a certicate issued by Us through
the Plan Sponsor terminates;
WithrespecttoaSpouse,thelastdayofthe
calendar month in which the marriage o the
Member and Dependent Spouse is dissolved;
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WithrespecttoaDependentchild,whenthe
child turns 26;
Therstdayofthecalendarmonthinwhicha
Covered Person attains age 65, unless the Covered
Persons birth date is the rst o the month, then
coverage will end on the rst day o the monthprior to the Covered Persons birth date; or
Therstdayofthecalendarmonthinwhicha
Covered Person becomes eligible or Medicare.
When Coverage or the Member ends because the
member becomes eligible or Medicare, Coverage or
a Spouse and any Dependent child(ren) or the lie
insurance benets will end on the date the member
becomes eligible or Medicare.
HEALTH NET VISION AND DENTAL
ExcLuSIONS & LIMITATIONS
Please reer to a Health Net Vision and Dental
Schedule o Benets or inormation.
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Protect your health while you protect your budget.Health Net makes it easy.For more information, please contact:
Health NetPost Oce Box 1150Rancho Cordova, Caliornia 95741-1150
Individual & Family Plans:
1-800-909-3447
Telecommunications Devicefor the Hearing and Speech Impaired:
1-800-995-0852
www.healthnetworkjinsurance.com
6022928 CA73969 (1/11)Decision Power is not part o Health Nets commercial medical benet plans. Also, it is not aliated with Health Nets provider network and it may be revised or
withdrawn without notice. Decision Power services, including Health Coaches, are additional resources that Health Net makes available to enrollees oHealth Net o Caliornia and Health Net Lie Insurance Company.
Caliornia Farm Bureau Members Health Insurance Plans are underwritten by Health Net Lie Insurance Company. Health Net Dental HMO plans are providedby Dental Benet Providers o Caliornia, Inc. (DBP). Health Net Dental PPO and indemnity plans are underwritten by Unimerica Lie Insurance Company.Obligations o DBP and Unimerica Lie Insurance Company are not the obligations o or guaranteed by Health Net, Inc. or its aliates. Health NetVision is underwritten by Fidelity Security Lie Insurance Company and administered by EyeMed Vision Care, LLC. Fidelity Security Lie Insurance Companypolicy number VC-75 orm number C-9069CA Health Net Lie Insurance Company is a subsidiary o Health Net Inc Health Net and Decision Power are
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