Health Net - Silver 70 HMO

Health Net

Plan Coverage
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Doctor Visits

Primary Care
First 4 visits free
$45.00 Copay
Specialist
$70.00 Copay
Preventative Care
0

Prescriptions

Generic Drugs
$15.00 Copay
Brand Drugs
$50.00 Copay after deductible
Brand Drugs (Non-Preferred)
$70.00 Copay after deductible
Specialty Drugs
20% Coinsurance after deductible

Hospital

Emergency Room
$250.00 Copay after deductible
Ambulance
$250.00 Copay after deductible
Hospital Stay (Facility)
20% Coinsurance after deductible
Hospital Stay (Physician)
20% Coinsurance after deductible
Outpatient Procedure (Facility)
20% Coinsurance
Outpatient Procedure (Physician)
20% Coinsurance

Pregnancy

Delivery
20% Coinsurance after deductible
Well Baby Visits
0

Mental Health

Outpatient Services
$45.00 Copay
Psychiatric Hospital Stay
20% Coinsurance after deductible

Diagnostics / Labs / Imaging

X-Rays
$65.00 Copay
CT Scans, Pet Scans and MRIs
$250.00 Copay
Lab Tests
$35.00 Copay

Free Preventative Care

If you use an in-network doctor, this plan will provide all preventative care services at no cost.

List of covered services

Out of Network

If you use out-of-network providers under this plan, you may have to pay more or even full price. Out of Network care doesn't count towards your deductible and maximum out-of-pocket.