Health Net Gold Select (HMO)

Medicare Advantage Plan (Part C w/ RX)

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Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Health Net
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • Primary care physician office visit copay of $0
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$1,950 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
$0
Not Applicable
Inpatient Mental Health Care
$900 copay
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-20: $0 copay per day. Days 21-100: $75 copay per day
Not Applicable
Home Health Care
$0 maximum per visit
Not Applicable
Doctor Office Visits
$0 maximum per visit
Not Applicable
Outpatient Services
$60 maximum per visit
Not Applicable
Ambulance Services
$250 maximum
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Kidney Disease and Conditions
20% maximum per visit
Not Applicable
Specialist Office Visit
$0 maximum per visit
Not Applicable

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.


Drugs Covered under Medicare Part D

General

This plan uses a formulary. The plan will send you the formulary. You can also see the formulary at http://https://www.healthnet.com/medicare/pharmacy on the web.

Different out-of-pocket costs may apply for people who
  • have limited incomes,
  • live in long term care facilities, or
  • have access to Indian/Tribal/Urban (Indian Health Service) providers.


The plan offers national in-network prescription coverage (i.e., this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan's service area (for instance when you travel).

Total yearly drug costs are the total drug costs paid by both you and a Part D plan.

The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition.

Some drugs have quantity limits.

Your provider must get prior authorization from Health Net Gold Select (HMO) for certain drugs.

You must go to certain pharmacies for a very limited number of drugs, due to special handling, provider coordination, or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan's website, formulary, printed materials, as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov.

If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount.

If you request a formulary exception for a drug and Health Net Gold Select (HMO) approves the exception, you will pay Tier 4: Non-Preferred Brand cost sharing for that drug.

In-Network

$0 deductible.

Initial Coverage

You pay the following until total yearly drug costs reach $2,850:

Retail Pharmacy

Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

You can get drugs the following way(s):

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of drugs in this tier


  • $0 copay for a two-month (60-day) supply of drugs in this tier


  • $0 copay for a three-month (90-day) supply of drugs in this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of drugs in this tier


  • $20 copay for a two-month (60-day) supply of drugs in this tier


  • $30 copay for a three-month (90-day) supply of drugs in this tier


  • Tier 3: Preferred Brand

  • $45 copay for a one-month (30-day) supply of drugs in this tier


  • $90 copay for a two-month (60-day) supply of drugs in this tier


  • $135 copay for a three-month (90-day) supply of drugs in this tier


  • Tier 4: Non-Preferred Brand

  • $95 copay for a one-month (30-day) supply of drugs in this tier


  • $190 copay for a two-month (60-day) supply of drugs in this tier


  • $285 copay for a three-month (90-day) supply of drugs in this tier


  • Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier


  • 33% coinsurance for a two-month (60-day) supply of drugs in this tier


  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of drugs in this tier


  • $0 copay for a two-month (60-day) supply of drugs in this tier


  • $0 copay for a three-month (90-day) supply of drugs in this tier


Long Term Care Pharmacy

Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

You can get drugs the following way(s):

Tier 1: Preferred Generic

  • $0 copay for a one-month (34-day) supply of drugs in this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (34-day) supply of drugs in this tier


  • Tier 3: Preferred Brand

  • $45 copay for a one-month (34-day) supply of drugs in this tier


  • Tier 4: Non-Preferred Brand

  • $95 copay for a one-month (34-day) supply of drugs in this tier


  • Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (34-day) supply of drugs in this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (34-day) supply of drugs in this tier



Mail Order


Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

You can get drugs from a preferred and non-preferred mail order pharmacy the following way(s):

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $0 copay for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $0 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $20 copay for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $20 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $10 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $20 copay for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $30 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Tier 3: Preferred Brand

  • $45 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $90 copay for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $90 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $45 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $90 copay for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $135 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Tier 4: Non-Preferred Brand

  • $95 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $190 copay for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $238 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $95 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $190 copay for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $285 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • 33% coinsurance for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • 33% coinsurance for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • 33% coinsurance for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a two-month (60-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy.


  • $0 copay for a one-month (30-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $0 copay for a two-month (60-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


  • $0 copay for a three-month (90-day) supply of drugs in this tier from a non-preferred mail order pharmacy.


Coverage Gap

After your total yearly drug costs reach $2,850, you receive limited coverage by the plan on certain drugs. You will also receive a discount on brand name drugs and generally pay no more than 47.5% for the plan's costs for brand drugs and 72% of the plan's costs for generic drugs until your yearly out-of-pocket drug costs reach $4,550.

Additional Coverage Gap

The plan covers many formulary generics (65%-99% of formulary generic drugs), few formulary brands (less than 10% of formulary brand drugs) through the coverage gap.

The plan offers additional coverage in the gap for the following tiers. You pay the following:

Retail Pharmacy

Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of all drugs covered within this tier


  • $20 copay for a two-month (60-day) supply of all drugs covered within this tier


  • $30 copay for a three-month (90-day) supply of all drugs covered within this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier


Long Term Care Pharmacy

Long term care pharmacies must dispense brand name drugs in amounts less than a 14 days supply at a time. They may also dispense less than a month's supply of generic drugs at a time. Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

Tier 1: Preferred Generic

  • $0 copay for a one-month (34-day) supply of all drugs covered within this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (34-day) supply of all drugs covered within this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (34-day) supply of all drugs covered within this tier



Mail Order


Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed.

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $20 copay for a two-month (60-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $20 copay for a three-month (90-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $10 copay for a one-month (30-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $20 copay for a two-month (60-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $30 copay for a three-month (90-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier from a preferred mail order pharmacy


  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $0 copay for a two-month (60-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


  • $0 copay for a three-month (90-day) supply of all drugs covered within this tier from a non-preferred mail order pharmacy


Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $4,550, you pay the greater of:
  • 5% coinsurance, or
  • $2.55 copay for generic (including brand drugs treated as generic) and a $6.35 copay for all other drugs.


Out-of-Network

Plan drugs may be covered in special circumstances, for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Health Net Gold Select (HMO).

You can get out-of-network drugs the following way:

Out-of-Network Initial Coverage

You will be reimbursed up to the plan's cost of the drug minus the following for drugs purchased out-of-network until total yearly drug costs reach $2,850:

Out-of-Network Initial Coverage

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of drugs in this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of drugs in this tier


  • Tier 3: Preferred Brand

  • $45 copay for a one-month (30-day) supply of drugs in this tier


  • Tier 4: Non-Preferred Brand

  • $95 copay for a one-month (30-day) supply of drugs in this tier


  • Tier 5: Specialty Tier

  • 33% coinsurance for a one-month (30-day) supply of drugs in this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of drugs in this tier


Out-of-Network Coverage Gap

You will be reimbursed up to 28% of the plan allowable cost for generic drugs purchased out-of-network until total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s). You will be reimbursed up to 52.5% of the plan allowable cost for brand name drugs purchased out-of-network until your total yearly out-of-pocket drug costs reach $4,550. Please note that the plan allowable cost may be less than the out-of-network pharmacy price paid for your drug(s).

Additional Out-of-Network Coverage Gap

You will be reimbursed for these drugs purchased out-of-network up to the plan's cost of the drug minus the following:

Tier 1: Preferred Generic

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


  • Tier 2: Non-Preferred Generic

  • $10 copay for a one-month (30-day) supply of all drugs covered within this tier


  • Tier 6: Select Care Drugs

  • $0 copay for a one-month (30-day) supply of all drugs covered within this tier


Out-of-Network Catastrophic Coverage

After your yearly out-of-pocket drug costs reach $4,550, you will be reimbursed for drugs purchased out-of-network up to the plan's cost of the drug minus your cost share, which is the greater of:
  • 5% coinsurance, or
  • $2.55 copay for generic (including brand drugs treated as generic) and a $6.35 copay for all other drugs.



Optional Supplemental Benefits

Other Services

Inpatient Care

Doctor and Hospital Choice



In-Network

You must go to network doctors, specialists, and hospitals.

Referral required for network hospitals and specialists (for certain benefits).


,

Inpatient Hospital Care



In-Network

No limit to the number of days covered by the plan each hospital stay.

$0 copay

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


Outpatient Care

Inpatient Mental Health Care



In-Network

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

$900 copay for each Medicare-covered hospital stay.

Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


,

Skilled Nursing Facility (SNF)



General

Authorization rules may apply.

In-Network

Plan covers up to 100 days each benefit period

No prior hospital stay is required.

For Medicare-covered SNF stays:

  • Days 1 - 20: $0 copay per day


  • Days 21 - 100: $75 copay per day



,

Home Health Care



General

Authorization rules may apply.

In-Network

$0 copay for each Medicare-covered home health visit


,

Hospice



General

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.


,

Doctor Office Visits



General

Authorization rules may apply.

In-Network

$0 copay for each Medicare-covered primary care doctor visit.

$0 copay for each Medicare-covered specialist visit.


Outpatient Medical Services and Supplies

Chiropractic Services



General

Authorization rules may apply.

In-Network

$0 copay for each Medicare-covered chiropractic visit

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).


,

Podiatry Services



General

Authorization rules may apply.

In-Network

$0 copay for each Medicare-covered podiatry visit

$0 copay for up to 12 supplemental routine podiatry visit(s) every year

Medicare-covered podiatry visits are for medically necessary foot care.


,

Outpatient Mental Health Care



General

Authorization rules may apply.

In-Network

$25 copay for each Medicare-covered individual therapy visit

$25 copay for each Medicare-covered group therapy visit

$25 copay for each Medicare-covered individual therapy visit with a psychiatrist

$25 copay for each Medicare-covered group therapy visit with a psychiatrist

$0 copay for Medicare-covered partial hospitalization program services


,

Outpatient Substance Abuse Care



General

Authorization rules may apply.

In-Network

$25 copay for Medicare-covered individual substance abuse outpatient treatment visits

$25 copay for Medicare-covered group substance abuse outpatient treatment visits


,

Outpatient Services



General

Authorization rules may apply.

In-Network

$0 copay for each Medicare-covered ambulatory surgical center visit

$0 to $60 copay for each Medicare-covered outpatient hospital facility visit


,

Ambulance Services



General

Authorization rules may apply.

In-Network

$250 copay for Medicare-covered ambulance benefits.


,

Emergency Care



General

$65 copay for Medicare-covered emergency room visits

$50,000 plan coverage limit for supplemental emergency services outside the U.S. and its territories every year.

If you are immediately admitted to the hospital, you pay $0 for the emergency room visit.


,

Urgently Needed Care



General

$10 copay for Medicare-covered urgently-needed-care visits

If you are immediately admitted to the hospital, you pay $0 for the urgently-needed-care visit.


,

Outpatient Rehabilitation Services



General

Authorization rules may apply.

Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered.

In-Network

$0 copay for Medicare-covered Occupational Therapy visits

$0 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits


,

Durable Medical Equipment



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered durable medical equipment


Preventive Services

Prosthetic Devices



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered prosthetic devices

$0 copay for Medicare-covered medical supplies related to prosthetics, splints, and other devices


,

Diabetes Programs and Supplies



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered Diabetes self-management training

$0 copay for Medicare-covered Diabetes monitoring supplies

20% of the cost for Medicare-covered Therapeutic shoes or inserts

Diabetic Supplies and Services are limited to specific manufacturers, products and/or brands. Contact the plan for a list of covered supplies.


,

Diagnostic Tests, X-Rays, Lab Services, and Radiology Services



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered lab services

$0 copay for Medicare-covered diagnostic procedures and tests

$0 copay for Medicare-covered X-rays

$60 copay for Medicare-covered diagnostic radiology services (not including X-rays)

$60 copay for Medicare-covered therapeutic radiology services


,

Cardiac and Pulmonary Rehabilitation Services



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered Cardiac Rehabilitation Services

$0 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$0 copay for Medicare-covered Pulmonary Rehabilitation Services


Additional Benefits

Preventive Services



General

Authorization rules may apply.

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

In-Network

$0 copay for a supplemental annual physical exam


,

Kidney Disease and Conditions



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered renal dialysis

$0 copay for Medicare-covered kidney disease education services


,

Dental Services



In-Network

$0 copay for Medicare-covered dental benefits

$0 copay for supplemental oral exams

$0 copay for up to 2 supplemental cleaning(s) every year

$0 copay for up to 1 supplemental fluoride treatment(s) every year

$0 copay for up to 1 supplemental dental x-ray(s) every year

Plan offers additional supplemental comprehensive dental benefits.


,

Hearing Services



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered diagnostic hearing exams

$0 copay for up to 1 supplemental routine hearing exam(s) every year

$0 copay for up to 1 supplemental hearing aid fitting-evaluation(s) every three years

$0 copay each for up to 2 supplemental hearing aid(s) every three years

$1,000 plan coverage limit for supplemental hearing aids every three years.


,

Vision Services



In-Network

$0 to $25 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye, including an annual glaucoma screening for people at risk

$25 copay for up to 1 supplemental routine eye exam(s) every year

$0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.

$0 copay for up to 1 pair(s) of eyeglasses (lenses and frames) every two years

$0 copay for up to 1 pair(s) of contact lenses every two years

$0 copay for up to 1 pair(s) of eyeglass lenses every two years

$0 copay for up to 1 frame(s) every two years

$100 plan coverage limit for supplemental eyewear every two years


Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$10 copay$10 copay$10 copay
Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
Tier 4: Non-Preferred Brand Name$95 copay$95 copay$95 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copay$0 copay
Tier 2: Non-Preferred Generic$30 copay$30 copay$20 copay
Tier 3: Preferred Brand Name$135 copay$135 copay$90 copay
Tier 4: Non-Preferred Brand Name$285 copay$285 copay$238 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept Health Net Gold Select (HMO) for California

/
MULL, JOHN
4425 SOUTH CENTRAL AVE
LOS ANGELES, CA 90011
BAHARI-NEJAD, PEJMAN
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
KASHANI, HOUMAN
747 WAREHOUSE ST
LOS ANGELES, CA 90021
BLEAKLEY, DENNIS
515 E. 5TH STREET
LOS ANGELES, CA 90021
GREGERSON, PAUL
515 E. 5TH ST
LOS ANGELES, CA 90021
PRESS, MICHAEL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
EL-KHOUEIRY, ANTHONY
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
RUSSELL, CHRISTY
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
WANG, LINA
1500 SAN PABLO ST
LOS ANGELES, CA 90033
SHERROD, ANDY
1500 SAN PABLO ST
LOS ANGELES, CA 90033
NICHOLS, PETER
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
MARTIN, SUE
1500 SAN PABLO STREET
LOS ANGELES, CA 90039
LAI, ROSE
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
O'CONNELL, CASEY
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
WANG, WILLIAM
2020 ZONAL AVE
LOS ANGELES, CA 90089
KAO, VINCENT
2020 ZONAL AVE
LOS ANGELES, CA 90089
ROTHMAN, ELLEN
5701 S HOOVER ST
LOS ANGELES, CA 90037
MONTENEGRO, ROMEO
231 W VERNON AVE
LOS ANGELES, CA 90037
ANAKWENZE, VICKI
5260 S FIGUEROA ST
LOS ANGELES, CA 90037
BOWEN, RICHARD
2400 S. FLOWER ST.
LOS ANGELES, CA 90007
GORDON, MARTIN
2400 S FLOWER ST
LOS ANGELES, CA 90007
MARDER, VICTOR
2400 S FLOWER ST
LOS ANGELES, CA 90007
ADAMS, LINDA
2400 S FLOWER ST
LOS ANGELES, CA 90007
LATTOS, WILLIAM
2400 S FLOWER ST
LOS ANGELES, CA 90007
TIGNER-WEEKES, LINDA
515 W 27TH ST
LOS ANGELES, CA 90007
Details
JOHN MULL, MD MPH
Phone Number
(323) 908-4219
Office Locations
4425 SOUTH CENTRAL AVE
LOS ANGELES, CA 90011
4425 SOUTH CENTRAL AVE LOS ANGELES CA, 90011

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