Introduction
With the complex US healthcare system offering myriad insurance carrier and plan choices, understanding options can seem overwhelming. However, making informed coverage decisions is crucial for securing quality, affordable care and treatment access when needed. In this guide, we’ll provide an in-depth look at Health Net – one of the largest insurers in America serving millions of individuals, families and groups. By learning Health Net’s history, ownership structure, markets served, types of plans offered and special services, you’ll gain valuable insights into this prominent insurance provider.
To set the stage, let’s first define some key industry terms:
Managed Care Organization (MCO): An insurance company that manages healthcare delivery and costs through provider networks, utilization management and care coordination rather than just financing claims.
Preferred Provider Organization (PPO): A type of managed care plan featuring in-network providers for lower costs but allowing out-of-network use typically at a higher price.
Health Maintenance Organization (HMO): A more restrictive managed care structure only covering in-network care except in emergencies to encourage using designated physicians and facilities.
Understanding these different insurance models will help in assessing Health Net’s various plan structures later on.
Health Net’s History and Growth
Founded in 1973 in California, Health Net began as a non-profit HMO serving employer groups and individuals across the state. In the 1990s, it expanded operations nationally through acquisitions in multiple regions. Today its coverage footprint spans over 20 states.
In 2004, Health Net became a publicly traded, for-profit company still headquartered in Woodland Hills, CA. It has grown tremendously through the years now insuring over 7 million eligible members across Commercial, Medicaid, and Medicare markets.
A series of mergers and divestitures helped streamline business operations – selling non-core assets while acquiring new subsidiaries. Most notably, Centene Corporation completed purchasing Health Net for $6.8 billion in March 2016.
Centene now operates Health Net as a wholly owned subsidiary maintaining its established brand identities across local markets. Though under larger corporate governance, Health Net retains autonomy to manage member services, provider networks, and unique state-specific plans independently.
Health Net’s Insurance Products
Health Net provides a broad selection of insured managed care solutions tailored to specific customer segments:
Commercial Group Plans: PPO and HMO options for employer-sponsored coverage are available nationwide.
Individual & Family Plans: On and off-exchange major medical plans compliant with ACA regulations in participating states.
Medicare Advantage: HMO, PPO and specialized plans (HMO SNP) serving Medicare beneficiaries across 30+ states.
Medicaid Managed Care: Full-risk plans administering benefits to eligible recipients in multiple state programs.
Specialty Health Plans: Targeted offerings like dental, vision and life insurance available as standalone or bundled choices.
Self-Funded Administrative Services: Partnering with employers to customize benefits while Health Net processes claims administration only.
Health Net’s portfolio features robust healthcare solutions insured or administered across market sectors utilizing broad multi-state provider networks and geographical reach.
Health Net’s Network & Services
Central to Health Net’s managed care strategy is contracting preferred facilities and practitioners across designated service areas to deliver high-quality, affordable care. Key aspects include:
Large Provider Networks: Counting over 1 million physicians and care locations in total spanning affiliated regions.
Specialty Care Access: Contracting top hospitals, specialists, and ancillary providers for complex/unique treatment access.
Digital Tools: Member portals offering virtual visits, cost/doctor lookups, claims support, and wellness programs.
24/7 Nurse Line: Registered nurses are available by phone for non-emergency health questions and advice at no extra cost.
Care Management: Coordinators assist members with chronic conditions, complex cases, or transitions in care settings.
Quality Incentive Programs: Rewarding high-performing in-network providers and actively engaging low performers for improvements.
Preventive Benefits: Covering checkups, screenings, and vaccines at no charge to promote proactive health maintenance.
These services distinguish Health Net plans while driving better participant outcomes and total cost of care through principled managed care coordination.
Costs of Health Net Plans
Premium rates naturally vary depending on selected benefit design, geographic area, group/individual market factors, and one’s own eligibility profile (age, industry, family size, etc.). However, some general cost ranges include:
Commercial PPOs: Estimated monthly premiums average $450/individual or $1,150/family nationally.
ACA-Compliant Individual Plans: Current average premiums are around $500/month after subsidies for Bronze or Silver-tier plans.
Medicare Advantage: Yearly Part B premium ($170.10 standard monthly in 2023) plus average monthly Part C premium of $30.
Medicaid Managed Care: No costs to qualifying individuals as premiums are covered by state/federal funding per member per month rates.
Be sure to get actual quotes accounting for your specific situation from an agent or Health Net representative. Understand all out-of-pocket limits and copays too when budgeting total expenses for certain plans versus others.
Filing Insurance Claims
As with using any commercial insurance, Health Net members are responsible for following the necessary procedures to access benefits:
Present ID cards to providers rendering eligible services.
Obtain necessary pre-certifications or referrals for specialist care as specified by plan type.
Pay applicable copays or coinsurance amounts owed at the time of visit or service.
Keep itemized statements and Explanation of Benefits (EOBs) for records.
Work directly with providers to submit secondary claims to other insurance when applicable.
File utilization review appeals as outlined in health plan documents if coverage denials occur.
Health Net processes most precertified claims within 30 days according to regulations. Mobile apps, member portal claims lookups, and customer service reps all aid in claims navigation and resolution as well.
Choosing Health Net Plans
In deciding if a Health Net plan matches individual or group coverage needs, evaluate the following key criteria:
Confirm provider access in the desired geographic area
Compare premium rates versus deductibles/copays tradeoffs
Assess included benefits like prescription drugs or mental health care
Consider chronic conditions and anticipated medical expenses
Check insurer/plan quality ratings from objective third parties
Review provider directory online or contact sales representatives
With proper due diligence, enrolling in a suitable Health Net plan tailored to budget and healthcare needs can ensure proper protection and care access when the unexpected occurs. Maintenance of good health is the ultimate goal.
The Bottom Line
In summary, Health Net has grown tremendously since 1973 now providing an array of comprehensive insurance solutions to millions nationwide. Central to its managed care model is partnering with vast preferred provider networks focused on whole-person wellness through clinically appropriate care coordination, digital services, and quality oversight. Understanding Health Net’s ownership structure, markets served, cost factors, and claims procedures empowers individuals to make informed choices selecting the best-fitting commercial, Medicaid, or Medicare plans for themselves or employer groups based on distinct needs and priorities. With proper plan selection and preventive care utilization, Health Net membership can keep individuals and families healthy while managing overall healthcare spending.
