HealthNet PPO/HMO Medical Insurance

Health Net

KES, Inc. provides its employees with two comprehensive medical plans with Health Net. Eligible participants have the option of choosing a PPO or HMO medical plan for themselves and their dependents as well as a PPO option for our employees who reside outside of California.

Health Net PPO - Health Net PPO provides the greatest amount of flexibility and choice in selecting medical providers. There’s no annual deductible prior to receiving any benefits within the Health Net Network. Office visits require a $10 co-pay, while hospitalization etc are covered at 90% with a maximum out-of-pocket expenses of $2,000.00 (per member/year) when using doctors within the Health Net PPO network. Coverage outside of the network is covered at 70% with a maximum out-of-pocket expense of $4,000. Please see the plan for more detail.

To view the PPO Plan Summary please click on this link: PPO Plan Summary

To view the PPO Schedule of Benefits please click on this link: PPO Schedule of Benefits

Health Net HMO - Health Net HMO provides a cost effective medical plan with a large network of doctors to choose from. There’s no annual deductible prior to receiving benefits. Office visits require a $20 co-pay, while hospitalization etc. are covered at 100% with a $250 admittance fee and the maximum out-of-pocket expense of $1,500 per member (three-member family max.) when using your primary care physician. Please see plan for more details.

To view the HMO Plan Summary please click on this link: HMO Plan Summary

To view the HMO Schedule of Benefits please click on this link: HMO Schedule of Benefits

IMPORTANT NOTE: You should notify HR immediately with any status changes such as marriage, divorce, birth of a child, or loss of coverage with another provider. The change form shown below can be used to make changes to your medical plan due to a qualifying event. Contact HR with any questions. Please note: Changes become effective on the 1st of the month following the submission of the requested change to your coverage.

To view a Health Net Change Form please click on this link: Change Form

If you haven't already done so you can register on the Health Net website to view your personal account information. Here is the link: http://www.healthnet.com. Click on I’m a Member towards the top of the screen, select California or the state in which you reside and then click on the “Register” button and follow the links.

You can access the following helpful links and more:

• Find a pharmacy near you
• Change primary care physician
• Print temporary id card
• Order a new id card
• My coverage information If you would like to perform a provider search on Health Net’s website please click this link: http://www.healthnet.com/.

Directions for Provider Search: There are two options to choose from one is a members search and several guest searches by provider name, street address, city or zip code. You can choose either option. If you do select the member search you will need your ID number located on your medical card.

If you are asked to select a plan type you will choose either Salud HMO Plus or PPO. You may then choose to select specific medical groups to search.

For Behavorial Health Assistance: If you are looking for assistance with substance abuse, marriage & family therapy, psychiatry and/or psychology etc. you will need to click on this link:

https://www.mhn.com/member/practitionerSearch.do?search=clear&key=pracSearch

On the next screen select Behavioral Health. On the following screen you will have the option to search by address, zip code or by provider name. If you are looking for a specific Behavorial Health provider but do not see them listed please call Member Services at 1-800-522-0088 to confirm whether or not they are accepting Health Net insurance.

Mail Service Pharmacy Information: Health Net also provides its members the option to have your prescriptions delivered to you at home or work with their Mail Order Pharmacy. Regular shipping is free and your prescriptions co-pay could be reduced. In general, for every prescription you fill through the Mail Order Pharmacy you can receive a three-month supply for the price equivalent of a two-month supply which would be $20 for Level 1, $50 for Level II and $80 for Level III. Potentially saving you the equivalent of one co-payment every three months. You can contact Member Services at 1-800-676-6976 for additional information. Or you can logon to the Health Net website at www.healthnet.com and click on View prescription coverage, get prescriptions by mail.

To view the Mail Order Pharmacy Brochure click here: Mail Order Pharmacy Brochure

To view the HMO Prescription Plan Summary click here: HMO Prescription Plan Summary

To view the PPO Prescription Plan Summary click here: PPO Prescription Plan Summary

*Open enrollment for Health Net is in January each year.