Health Net Gold 80 EnhancedCare PPO Plan Details for 2020- HealthPocket

Health Net Gold 80 EnhancedCare PPO

$0.00/mo

Apply For This Plan

Zip Code90011
Applicant8/5/1985 Male

Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameHealth Net Gold 80 EnhancedCare PPO
Plan IDexch-CA2019HealthNetGold80EnhancedCarePPO
Plan Year2019
Insurance ProviderHealth Net
Metal LevelGold
Plan TypePPO
Deductible$0
Out-of-Pocket Maximum$0
Plan Highlights

Yearly Deductible & Out-of-Pocket

Yearly Deductible - Individual$0
Yearly Deductible - Family$0
Separate Drug Deductible - Individual$0
Separate Drug Deductible - Family$0
Out-of-Pocket Max - Individual$7200
Out-of-Pocket Max - Family$14400
Maximum Cost per Prescription$250

Doctor Visit

Primary Care Visit$30 Copay
Specialist Visit$55 Copay
Other Practitioner Office Visit$30 Copay
Preventive Care/Screening/ImmunizationNo Charge

Tests

Laboratory Tests$35 Copay
X-rays and Diagnostic Imaging$55 Copay
Imaging (CT/PET Scans, MRIs)20% Coinsurance

Drugs

Tier 1 (Most Generic Drugs)$15 Copay
Tier 2 (Preferred Brand Drugs)$55 Copay
Tier 3 (Non-Preferred Brand Drugs)$75 Copay
Tier 4 (Specialty Drugs)20% Coinsurance

Outpatient Services

Outpatient Facility Fee20% Coinsurance
Outpatient Surgery Physician/Surgical Services20% Coinsurance
Outpatient Services Office Visits20% Coinsurance

ER & Urgent Care

Emergency Room Facility Fee$325 Copay
Emergency Transportation$250 Copay
Urgent Care$30 Copay
Emergency Room Professional FeeNo Charge

Hospital

Inpatient Hospital Services20% Coinsurance
Inpatient Physician and Surgical Services20% Coinsurance

Mental/Behavioral Health

Mental/Behavioral Health Outpatient Services$30 Copay
Mental/Behavioral Health Inpatient Facility Fee20% Coinsurance
Mental/Behavioral Health Inpatient Professional Fee20% Coinsurance
Substance Use Disorder Outpatient Services$30 Copay
Substance Use Disorder Inpatient Facility Fee20% Coinsurance

Pregnancy

Prenatal CareNo Charge
Delivery and Maternity Care Inpatient Facility Fee20% Coinsurance
Delivery and Maternity Care Inpatient Professional Fee20% Coinsurance

Other Special Needs

Home Health Care Services20% Coinsurance
Outpatient Rehabilitation Services$30 Copay
Habilitation Services$30 Copay
Skilled Nursing Facility20% Coinsurance
Durable Medical Equipment20% Coinsurance
Hospice ServicesNo Charge
Acupuncture$30 Copay
Rehabilitative Speech Therapy$30 Copay
Rehabilitative Occupational and Rehabilitative Physical Therapy$30 Copay
Well Baby Visits and CareNo Charge
Allergy Testing$55 Copay
Diabetes EducationNo Charge
Nutritional CounselingNot covered

Children's Vision

Eye Exam for ChildrenNo Charge
Eyeglasses for ChildrenNo Charge

Children's Dental

Child Filling - One Surface20% Coinsurance
Child Dental CheckupNo Charge
Child Root Canal - Molar50% Coinsurance
Child Medically Necessary Orthodontia50% Coinsurance
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  • Phone Number
    (323) 918-2700
  • Office Locations
    4800 S Central Ave
    Los Angeles, CA 90011
4800 S Central Ave Los Angeles CA, 90011
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket.com provides information on insurance products. If you choose to obtain a quote or apply for an insurance plan, you may be transferred to a partner website to complete your request. Always review the privacy and terms of use of the partner website.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).