1. Health Net
SDCERS
Audrey Mueller Rollins

2. Suite of Offerings Non-Medicare (Early Retirees) Medicare (Retirees)
Pam White Health Net
Privileged & Confidential

3. Non-Medicare Plans HMO PPO Out-of-State PPO
Pam White Health Net
Privileged & Confidential

4. In-Network Only (Primary Care Physician Required)
HMO Plan (Non-Medicare)
Medical Plan Features
In-Network Only (Primary Care Physician Required)
Calendar Year Deductible
None
Out-of-Pocket Maximum
(Individual/Family)
$1,500/$3,000
Physician Office Visit Copay (Primary& Specialist)
$20 copay
Lab & X-ray
CT, MRI or PET
No charge
Inpatient Hospitalization
$100 copay
Outpatient Surgery
$50 copay
Emergency Room Visit (waived if admitted)
$75 copay
Ambulance
Prescription Coverage (30-day supply)
$15 Generic/$30 Brand
Prescription by Mail (90-day supply)
$30 Generic/$60 Brand

5. PPO Plan (Non-Medicare)
Medical Plan Features
In-Network Only
Out- of- Network
Calendar Year Deductible (Individual/Family)
$500 /$1,500
(PPO/OON combined)
Out-of-Pocket Maximum
(Individual/Family)
$3,000/$9,000
$6,000/$18,000
Physician Office Visit Copay (Primary/Specialist)
$25 copay
40% after deductible
Lab & X-ray /CT, MRI or PET
20% after deductible
Inpatient Hospitalization
Outpatient Surgery
Emergency Room Visit
(deductible waived if admitted)
(additional $100 if not admitted)
Ambulance
$50+20% after deductible
$50+40% after deductible
Prescription Coverage
(30-day supply)
$15 Generic/$30 Brand
$15+50% AWP/Retail (Generic)
$30+50% AWP/Retail (Brand)
Prescription by Mail
(90-day supply)
$30 Generic/$60 Brand

6. Out-Of-State PPO Plan (Non-Medicare)
Medical Plan Features
In-Network Only
Out- of- Network
Calendar Year Deductible (Individual/Family)
$500 /$1,500
(PPO/OON combined)
Out-of-Pocket Maximum
(Individual/Family)
$3,000/$9,000
$6,000/$18,000
Physician Office Visit Copay (Primary/Specialist)
$25 copay
40% after deductible
Lab & X-ray /CT, MRI or PET
20% after deductible
Inpatient Hospitalization
Outpatient Surgery
Emergency Room Visit
(deductible waived if admitted)
(additional $100 if not admitted)
Ambulance
$50+20% after deductible
$50+40% after deductible
Prescription Coverage
(30-day supply)
$15 Generic/$30 Brand
$15+50% AWP/Retail (Generic)
$30+50% AWP/Retail (Brand)
Prescription by Mail
(90-day supply)
$30 Generic/$60 Brand

7. Medicare Plans Seniority Plus HMO COB Flex Net COB
Pam White Health Net
Privileged & Confidential

8. In-Network Only (Primary Care Physician Required)
Seniority Plus (Medicare Advantage Plan)
Works like a traditional HMO plan where PCP coordinates care
Retirees must have both Medicare Part A and Medicare Part B
Retirees “assign” their Medicare to Health Net.
Health Net provides all Medicare covered services
Part D prescription drug coverage and benefits administered by Health Net.
Medical Plan Features
In-Network Only (Primary Care Physician Required)
Calendar Year Deductible
None
Out-of-Pocket Maximum
$3,400
Physician Office Visit Copay
$10 copay
Lab & X-ray, CT, MRI or PET
No charge
Inpatient Hospitalization
Outpatient Surgery
$50 copay
Emergency Room Visit (waived if admitted)
Prescription Coverage (30-day supply)
$10 Generic/$20 Brand
Prescription by Mail (90-day supply)
$30 Generic/$60 Brand

9. Flex Net COB
NOT a Medicare Advantage Plan (benefits are NOT assigned to Health Net).
An Indemnity Plan
No provider network. You can go to any physician who accepts Medicare assignment
Retirees must have Medicare Part A and B for benefit coordination
Part D prescription drug is administered by Silverscripts so members of this plan will have two cards (medical ID card and pharmacy ID card)
Medical Plan Features
Calendar Year Deductible
None
Out-of-Pocket Maximum (Indiv/Family)
$6,350/$12,700
Physician Office Visit Copay (Primary/Specialist)
No charge
Lab & X-ray, CT, MRI or PET
Inpatient Hospitalization
Varies by number of days
Outpatient Surgery
Emergency Room Visit (in U.S.; waived if admitted)
Prescription Coverage (30-day supply)
$10 Generic/$20 Brand/$35 Non-Formulary/25% Spec
Prescription by Mail (90-day supply)
$30 Generic/$60 Brand/$105 Non-Formulary/25% Spec

10. In-Network Only (Primary Care Physician Required)
HMO COB
Works like a traditional HMO plan where PCP coordinates care
Retirees must have Medicare Part A and B for coordination
Retirees do NOT assign their Medicare benefits to Health Net
Medicare pays first; Health Net second
Part D prescription drug is administered by Silverscripts so members of this plan will have two cards (medical ID card and pharmacy ID card)
Medical Plan Features
In-Network Only (Primary Care Physician Required)
Calendar Year Deductible
None
Out-of-Pocket Maximum (Indiv/Family)
$1,500 / $3,000
Physician Office Visit Copay (Primary/Specialist)
$15
Lab & X-ray, CT, MRI or PET
No charge
Inpatient Hospitalization
$100 per admit
Outpatient Surgery
$50
Emergency Room Visit (waived if admitted)
Prescription Coverage (30-day supply)
$15 Generic/$30 Brand/$50 Non-Formulary/25% Spec
Prescription by Mail (90-day supply)
$45 Generic/$90 Brand/$150 Non-Formulary/25% Spec

11. Privileged & Confidential
Member Perks
Pam White Health Net
Privileged & Confidential

12. Decision Power Nurse 24 (Nurse Advice)
Decision Power Nurse 24 - Registered nurses are available 24 hours a day, 7 days a week answer any of your health questions.
Talk to a Registered Nurse - a trained professional, available 24 hours a day, to support you for any and every health question, goal or situation. Ask about our intensive education programs for weight loss and tobacco cessation.
Benefits of Nurse 24
Prevent unnecessary office/ER visits
Reinforce treatment plans
Empower participants
Ability to immediately address
special needs

13. Discount Programs
All our Health Net members are rewarded with discounts regardless which plan you sign-up on. So look for this flyer in your packets.
Some of the discounts that you’ll receive;
Receive a 25% discount off the usual and customary fees from contracted acupuncturists, chiropractors and massage therapists.
Through the ChooseHealthystore, you can buy vitamins, minerals and herbal supplements at a discount – up to 40% off the suggested retail price.
Health Net members receive free standard shipping on most orders.
For Gym’s a minimum 10% discount off initiation and/or monthly dues.
Last but not least, popular Weight Management programs; with Jenny Craig and Weight Watchers.

14. Health Coaching Complimentary! > Weight Loss > Nutrition
> Exercise
> Stress
> Smoking Cessation
Wellness health coaching
Based on your HRQ results, you may be
eligible for wellness health coaching, giving
you unlimited access to a registered dietitian,
respiratory therapist, health educator, or
social worker, offering ongoing support in
reaching your goals and sustaining positive
behavioral changes.
Our whole-person approach reduces the risk of
preventable diseases, such as coronary artery
disease and diabetes and promotes healthy
behaviors, including, but not limited to: • Healthy weight maintenance.
• Smoking and tobacco cessation
(See Quit for Life® below).
• Physical activity.
• Healthy eating and
nutrition.
• Managing stress.

15. Healthy Living Programs & On-line Seminars
Classes on emotional health, exercise, nutrition, smoking cessation, stress management, and weight management. 

16. Silver & Fit * – Fitness/Gym
* This program is limited to Health Net Seniority Plus members

17. Silver & Fit* - Chiropractic
No PCP Referral
Required!
To locate a participating chiropractor near you, go to
* This program is limited to Health Net Seniority Plus members

18. Thank you!