Individual Health Insurance - Health Net Life Insurance Company Resources

Plans Offered:

FirstChoice PPO:

HMO 15:

HMO 40:

NetSaver 1500:

PPO Value 25:

PPO Value 30:

PPO Value Basic 1000:

PPO Value Basic 2500:

PPO Value Basic 4000:

SimpleChoice HSA:

SimpleChoice PPO 15:

SimpleChoice PPO 25:

SimpleChoice PPO 35:

SimpleChoice PPO 40:

SimpleChoice PPO 50:

SimpleValue 30:

SimpleValue 40:

SimpleValue 50:

SmartChoice HSA:

ValueChoice 1500:

Plan Name	FirstChoice PPO
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	3
Plan Out of Network Deductible Benefit	$3,000 per person, 2 per family
Plan Coinsurance Benefit	You pay 30% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$3,750/ 2 per family combined in- and out-of-network (includes deductible)
Plan Out of Network Pocket Maximum Benefit	$3,750/ 2 per family combined in- and out-of-network (includes deductible)
Plan Family Out of Pocket Maximum Benefit	$3,750/ 2 per family combined in- and out-of-network (includes deductible)
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$20 copay plus 30% for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$20 copay plus 30% for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	You pay 30% of covered expenses for selected services
Plan Inpatient Hospital Benefit	$250 per admission copay plus 30%
Plan Outpatient Surgery Benefit	$250 per admission copay plus 30%
Plan Office Visits Benefit	You pay 30% of covered expenses for selected services
Plan Urgent Care Benefit	$40 copay plus 30%
Plan Emergency Care Benefit	$80 copay plus 30%
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$15 Level 1 (generic)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	HMO 15
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for comprehensive coverage.
Plan Deductible Benefit	0
Plan Out of Network Deductible Benefit	No coverage out of network (emergency only)
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	No coverage out of network (emergency only)
Plan Out of Pocket Maximum Benefit	$3,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	No coverage out of network (emergency only)
Plan Family Out of Pocket Maximum Benefit	$6,000 in network(includes deductibles)
Maternity Benefit	Covered in full after inpatient hospital services deductible is met
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$15 copay
Plan Child Preventive Care Benefit	$15 copay
Plan Lab & X-Ray Benefit	Covered in full
Plan Inpatient Hospital Benefit	$1,000 calendar year deductible then covered in full
Plan Outpatient Surgery Benefit	$250 copay
Plan Office Visits Benefit	$15 copay
Plan Urgent Care Benefit	$25 copay
Plan Emergency Care Benefit	$75 copay (waived if admitted)
Plan Ambulance Service Benefit	$50 copay
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $25 copay brand name; $50 copay non-formulary
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	HMO 40
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for comprehensive coverage.
Plan Deductible Benefit	0
Plan Out of Network Deductible Benefit	No coverage out of network (emergency only)
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	No coverage out of network (emergency only)
Plan Out of Pocket Maximum Benefit	$3,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	No coverage out of network (emergency only)
Plan Family Out of Pocket Maximum Benefit	$6,000 in network(includes deductibles)
Maternity Benefit	Covered in full after inpatient hospital services deductible is met
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay
Plan Child Preventive Care Benefit	$40 copay
Plan Lab & X-Ray Benefit	Covered in full
Plan Inpatient Hospital Benefit	$1,500 calendar year deductible then covered in full
Plan Outpatient Surgery Benefit	$250 copay
Plan Office Visits Benefit	$40 copay
Plan Urgent Care Benefit	$40 copay
Plan Emergency Care Benefit	$100 copay (waived if admitted)
Plan Ambulance Service Benefit	$80 copay
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $25 copay brand name; $50 copay non-formulary
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	NetSaver 1500
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	1500
Plan Out of Network Deductible Benefit	$1,500 per person, $3,000 per family
Plan Coinsurance Benefit	You pay 25% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$4,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$8,000 in network; $8,000 out of network (includes deductibles)
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	Subject to deductible and coinsurance for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	Subject to deductible and coinsurance for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Not covered until out of pocket is met, then covered in full
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	Not covered until out of pocket is met, then covered in full
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	Not covered
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	PPO Value 25
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for expanded coverage with an extensive provider network.
Plan Deductible Benefit	1000
Plan Out of Network Deductible Benefit	$1,000 per person, $2,000 per family
Plan Coinsurance Benefit	You pay 25% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$10,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$8,000 in network; no limit for out of network (includes deductibles)
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$25 copay for annual OB/GYN, Pap, Mammography and Prostate screening. $50 copay for annual routine physical.
Plan Child Preventive Care Benefit	$25 copay for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Subject to deductible and coinsurance
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance plus a $250 copay
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance plus a $250 copay
Plan Office Visits Benefit	$25 copay
Plan Urgent Care Benefit	$25 copay then subject to coinsurance (deductible waived)
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus a $50 copay per visit
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $35 copay brand name; $50 copay non-formulary
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	PPO Value 30
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for expanded coverage with an extensive provider network.
Plan Deductible Benefit	2500
Plan Out of Network Deductible Benefit	$2,500 per person, $5,000 per family
Plan Coinsurance Benefit	You pay 30% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,500 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$10,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$9,000 in network; no limit for out of network (includes deductibles)
Maternity Benefit	Subject to deductible and coinsurance
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$30 copay for annual OB/GYN, Pap, Mammography and Prostate screening. $60 copay for annual routine physical.
Plan Child Preventive Care Benefit	$30 copay for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Subject to deductible and coinsurance
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance plus a $250 copay
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance plus a $250 copay
Plan Office Visits Benefit	$30 copay
Plan Urgent Care Benefit	Subject to coinsurance (deductible waived) plus a $30 copay per vist
Plan Emergency Care Benefit	Subject to deductible and coinsurance plus a $60 copay per visit
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $35 copay brand name; $50 copay non-formulary
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	PPO Value Basic 1000
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	1000
Plan Out of Network Deductible Benefit	$1,000 per person, $2,000 per family
Plan Coinsurance Benefit	You pay 25% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$3,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$3,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$6,000 in network; $6,000 out of network (includes deductibles)
Maternity Benefit	Subject to deductible and coinsurance
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	Subject to deductible and coinsurance for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	Subject to deductible and coinsurance for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Not covered until out of pocket is met, then covered in full
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	Not covered until out of pocket is met, then covered in full
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $35 copay brand name; $50 copay non-formulary; $500 calendar year maximum
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	PPO Value Basic 2500
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	2500
Plan Out of Network Deductible Benefit	$2,500 per person, $5,000 per family
Plan Coinsurance Benefit	You pay 0% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$2,500 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$10,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$5,000 in network; no limit for out of network (includes deductibles)
Maternity Benefit	Subject to deductible and coinsurance
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	Subject to deductible and coinsurance for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	Subject to deductible and coinsurance for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Subject to deductible and coinsurance
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	Subject to deductible and coinsurance
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $35 copay brand name; $50 copay non-formulary
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	PPO Value Basic 4000
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	4000
Plan Out of Network Deductible Benefit	$4,000 per person, $8,000 per family
Plan Coinsurance Benefit	You pay 0% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$10,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$8,000 in network; no limit for out of network (includes deductibles)
Maternity Benefit	Subject to deductible and coinsurance
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$40 copay for checkups, immunizations, vision and hearing exams.
Plan Lab & X-Ray Benefit	Subject to deductible and coinsurance
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	$40 copay
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$100 deductible; $15 copay generic; $35 copay brand name; $50 copay non-formulary; $1,000 calendar year maximum
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice HSA
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	4000
Plan Out of Network Deductible Benefit	$4,000 per person, $8,000 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$4,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$8,000 - includes deductible
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$40 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	Covered in full after deductible is met
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice PPO 15
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extended coverage with an extensive provider network.
Plan Deductible Benefit	1500
Plan Out of Network Deductible Benefit	$1,500 per person, 2 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Out of Network Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Family Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only/ 2 per family
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$15 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$15 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	$5 Level 1 (generic) $250 brand deductible $35 Level II (brand) $50 Level III (non-formulary)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice PPO 25
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	2500
Plan Out of Network Deductible Benefit	$2,500 per person, 2 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Out of Network Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Family Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$25 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$25 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	$5 Level 1 (generic) $250 brand deductible $35 Level II (brand) $50 Level III (non-formulary)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice PPO 35
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	3500
Plan Out of Network Deductible Benefit	$3,500 per person, 2 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Out of Network Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Family Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$35 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$35 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	$5 Level 1 (generic) $250 brand deductible $35 Level II (brand) $50 Level III (non-formulary)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice PPO 40
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	4000
Plan Out of Network Deductible Benefit	$4,000 per person, 2 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Out of Network Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Family Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Maternity Benefit	Covered in full after deductible is met
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$40 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	$5 Level 1 (generic) $250 brand deductible $35 Level II (brand) $50 Level III (non-formulary)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleChoice PPO 50
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	5000
Plan Out of Network Deductible Benefit	$5,000 per person, 2 per family
Plan Coinsurance Benefit	None
Plan Out of Network Coinsurance Benefit	None
Plan Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Out of Network Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Plan Family Out of Pocket Maximum Benefit	Each member must meet calendar year deductible only, 2 per family
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$40 copay (deductible waived) for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after deductible is met
Plan Inpatient Hospital Benefit	Covered in full after deductible is met
Plan Outpatient Surgery Benefit	Covered in full after deductible is met
Plan Office Visits Benefit	Covered in full after deductible is met
Plan Urgent Care Benefit	Covered in full after deductible is met
Plan Emergency Care Benefit	Covered in full after deductible is met
Plan Ambulance Service Benefit	Covered in full after deductible is met
Plan Prescription Drug Benefit	$5 Level 1 (generic) $250 brand deductible $35 Level II (brand) $50 Level III (non-formulary)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleValue 30
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	0
Plan Out of Network Deductible Benefit	None
Plan Coinsurance Benefit	You pay 30% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Out of Network Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Family Out of Pocket Maximum Benefit	N/A
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$30 copay for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$30 copay for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	You pay 30% of covered expenses for selected services
Plan Inpatient Hospital Benefit	$400 copay per day/ 4 day maximum plus 30%
Plan Outpatient Surgery Benefit	$400 copay plus 30%
Plan Office Visits Benefit	$30 copay
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	$50 copay plus 30%
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	1) Combo $10 Level I (generic) $750 brand deductible $35 Level II (brand) $50 or 50% (whichever is greater) Level III (non-formulary) 2) Generic Only $10 Level I (generic)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleValue 40
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	0
Plan Out of Network Deductible Benefit	None
Plan Coinsurance Benefit	You pay 40% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Out of Network Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Family Out of Pocket Maximum Benefit	N/A
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$40 copay for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$40 copay for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	You pay 40% of covered expenses for selected services
Plan Inpatient Hospital Benefit	$400 copay per day/ 4 day maximum plus 40%
Plan Outpatient Surgery Benefit	$400 copay plus 40%
Plan Office Visits Benefit	$40 copay
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	$50 copay plus 40%
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	1) Combo $10 Level I (generic) $750 brand deductible $35 Level II (brand) $50 or 50% (whichever is greater) Level III (non-formulary) 2) Generic Only $10 Level I (generic)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SimpleValue 50
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extensive coverage with an extensive provider network.
Plan Deductible Benefit	0
Plan Out of Network Deductible Benefit	None
Plan Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Out of Network Pocket Maximum Benefit	$7,500 (combined in- and out-of-network)
Plan Family Out of Pocket Maximum Benefit	N/A
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$50 copay for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$50 copay for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	You pay 50% of covered expenses for selected services
Plan Inpatient Hospital Benefit	$400 copay per day/ 4 day maximum plus 50%
Plan Outpatient Surgery Benefit	$400 copay plus 50%
Plan Office Visits Benefit	$50 copay
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	$50 copay plus 50%
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	1) Combo $10 Level I (generic) $750 brand deductible $35 Level II (brand) $50 or 50% (whichever is greater) Level III (non-formulary) 2) Generic Only $10 Level I (generic)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	SmartChoice HSA
Details Brochure	No brochure available
Plan Description Benefit	This plan offers competitive premiums for extended coverage with an extensive provider network.
Plan Deductible Benefit	2500
Plan Out of Network Deductible Benefit	$2,500 per person, $5,000 per family
Plan Coinsurance Benefit	You pay 30% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$4,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	$10,000 - includes deductible
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	$35 copay (deductible waived) for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	$35 copay (deductible waived)for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	You pay 30% of covered expenses for selected services
Plan Inpatient Hospital Benefit	$250 per admission copay plus 30%
Plan Outpatient Surgery Benefit	$250 copay plus 30%
Plan Office Visits Benefit	You pay 30% of covered expenses for selected services
Plan Urgent Care Benefit	$50 copay plus 30%
Plan Emergency Care Benefit	$70 copay plus 30%
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	Subject to deductible and coinsurance
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

Plan Name	ValueChoice 1500
Details Brochure	No brochure available
Plan Description Benefit	This plan offers reduced premiums for basic coverage with an extensive provider network.
Plan Deductible Benefit	1500
Plan Out of Network Deductible Benefit	$1,500
Plan Coinsurance Benefit	You pay 25% of covered expenses for selected services
Plan Out of Network Coinsurance Benefit	You pay 50% of covered expenses for selected services
Plan Out of Pocket Maximum Benefit	$4,000 - includes deductible
Plan Out of Network Pocket Maximum Benefit	$4,000 - includes deductible
Plan Family Out of Pocket Maximum Benefit	N/A
Maternity Benefit	Not covered
Plan Lifetime Maximum Benefit	$6,000,000
Plan Preventive Care Benefit	25% for annual OB/GYN, Pap, Mammography and Prostate screening. Annual routine physicals not covered.
Plan Child Preventive Care Benefit	25% for checkups, immunizations, vision and hearing exams. Additional $30 copay for each immunization.
Plan Lab & X-Ray Benefit	Covered in full after out-of-pocket maximum is met
Plan Inpatient Hospital Benefit	Subject to deductible and coinsurance
Plan Outpatient Surgery Benefit	Subject to deductible and coinsurance
Plan Office Visits Benefit	Covered in full after out-of-pocket maximum is met
Plan Urgent Care Benefit	Subject to deductible and coinsurance
Plan Emergency Care Benefit	Subject to deductible and coinsurance
Plan Ambulance Service Benefit	Subject to deductible and coinsurance
Plan Prescription Drug Benefit	$15 Level 1 (generic)
Plan Supplemental Accident Benefit	Not covered
Plan Pre-Existing Conditions Benefit	There is no coverage for the first 6 consecutive months during which the member is insured by the plan.

BC Life and Health
Blue Cross of California
Celtic Insurance Company
PacifiCare Health Systems
Time Insurance Company
UniCare Life and Health Insurance Company
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Name:	Health Net Life Insurance Company
Description:	Health Net Life Insurance Company is a member of Health Net, Inc., one of the nation's largest managed health care companies. The company's various programs provide health care coverage to over 5.3 million people nationwide.
Website:
Customer Service:	1-800-909-3447
Address:	21650 Oxnard Street Woodland Hills, CA 91367
Not Offered by QuickQuote in:	All states except for CA
Year Founded:	1979
AM Best Rating:	B++ as of 2006
S&P Rating:	BBB