Health Net Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500 (Arizona)

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Company Health Net of Arizona
Plan Year 2014
State Arizona
Metal Tier Gold
Plan Type HMO
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $0
Deductible (Family) $0
Coinsurance 30%
Out of Pocket Maximum (Individual) $6,000
Out of Pocket Maximum (Family) $12,000

Doctors Visits

Primary Care Visit $30
Specialist Visit $60
In Patient Hospital Services $500 Copay per Day
Emergency Room Services $150

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $250 copay
Laboratory Outpatient and Professional Services $0
X-ray and Diagnostic Imaging $60 copay

Other

Mental / Behavioral Health $30 copay
Rehabilitative Speech Therapy $30 copay
Rehabilitative Occupational & Physical Therapy $30 copay
Outpatient Facility 30% coinsurance
Outpatient Surgery 30% coinsurance

Prescription Drugs

Generic Rx $20
Preferred Brand Rx $50
Non Preferred Brand Rx $70
Specialty Drugs 30%

Other Plans

Other plans that are available in the state.

Plan Name
PPO Platinum $15/$30/$1000 with Pediatric Dental
PPO Platinum $15/$30/$750 with Pediatric Dental
PPO Platinum $15/$30/$500 with Pediatric Dental
PPO Gold $25/$50/$2500 with Pediatric Dental
PPO Gold $25/$50/$1500 with Pediatric Dental
PPO Gold $25/$50/$500 with Pediatric Dental
PPO Platinum $15/$30/$1000 without Pediatric Dental
PPO Platinum $15/$30/$750 without Pediatric Dental
PPO Platinum $15/$30/$500 without Pediatric Dental
PPO Gold $25/$50/$2500 without Pediatric Dental
PPO Gold $25/$50/$1500 without Pediatric Dental
PPO Gold $25/$50/$500 without Pediatric Dental
PPO Silver 30%/30%/$1500 with Pediatric Dental
PPO Bronze 50%/50%/$5500 with Pediatric Dental
PPO Silver 30%/30%/$1500 without Pediatric Dental
PPO Bronze 50%/50%/$5500 without Pediatric Dental
CommunityCare HMO Bronze 40%/40%/$5000 With Pediatric Dental
CommunityCare HMO Basic 0%/0%/$6350 With Pediatric Dental
CommunityCare HMO Bronze 40%/40%/$5000 Without Pediatric Dental
CommunityCare HMO Basic 0%/0%/$6350 Without Pediatric Dental
CommunityCare HMO Platinum $15/$30/$3000 with Pediatric Dental
CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental
CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental
CommunityCare HMO Platinum $15/$30/$3000 without Pediatric Dental
CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental
CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental

Comments And Questions

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