2020 Health Net Seniority Plus Sapphire Premier II (HMO) H3561-5-0 in CA from Health Net | HealthPocket

Health Net Seniority Plus Sapphire Premier II (HMO)

$32/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealth Net
Plan IDH3561-5-0
Plan Year2020
CMS Rating
Plan TypeHMO
Annual Deductible$410.00
Out-of-Pocket Maximum6700

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage

Overview

Premium
Total monthly premium$32.00
Health plan premium$0.00
Drug plan premium$32.00
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$410.00
Estimated yearly costs
Estimated total yearly costs for care$4,482.00
Out-of-pocket max
Out-of-pocket max$6,700 In-network

Benefits & costs

Doctor services
Primary doctor visit$0 copay
Specialist visit$0 copay
Tests, labs, & imaging
Diagnostic tests & procedures20%
Lab services$0 copay
Diagnostic radiology services (like MRI)20%
Outpatient x-rays20%
Emergency care$90 per visit (always covered)
Urgent care20% per visit (always covered)
Hospital services
Inpatient hospital coverageComing soon
Outpatient hospital coverage20% per visit
Skilled nursing facility
Skilled nursing facilityComing soon
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance20%
Therapy services
Occupational therapy visit$0 copay
Physical therapy & speech & language therapy visit$0 copay
Mental health services
Outpatient group therapy with a psychiatrist20%
Outpatient individual therapy with a psychiatrist20%
Outpatient group therapy visit20%
Outpatient individual therapy visit20%
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)20% per item
Prosthetics (like braces, artificial limbs)20% per item
Diabetes supplies20% per item

Extra benefits & costs

Hearing
Hearing exam20%
Fitting/evaluation$0 copay
Hearing aids - All types$0-1,350
Preventive dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-raysNot covered
Comprehensive dental
Non-routine services$0 copay
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye exam$0 copay
Contact lenses$0 copay
Eyeglasses (frames & lenses)$0 copay
Eyeglass frames (only)Not covered
Eyeglass lenses (only)Not covered
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Transportation services for non-emergency care: Any health-related locationsNot covered
Transportation services for non-emergency care: Plan-approved locationsLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Routine chiropractic serviceLimited coverage
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsLimited coverage
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugs20%
Other Part B drugs20%

Coverage Area for Health Net Seniority Plus Sapphire Premier II (HMO)

StateCalifornia
CountyLos Angeles

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copayNot offered$0 copay
Tier 2: Non-Preferred GenericNot offereds$20 copayNot offered$20 copay
Tier 3: Preferred Brand NameNot offereds$47 copayNot offered$47 copay
Tier 4: Non-Preferred Brand NameNot offereds$100 copayNot offered$100 copay
Tier 5: Specialty TierNot offereds25% coinsuranceNot offered25% coinsurance
Tier 6: Select Care DrugsNot offereds$0 copayNot offered$0 copay

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copayNot offered$0 copay
Tier 2: Non-Preferred GenericNot offereds$40 copayNot offered$40 copay
Tier 3: Preferred Brand NameNot offereds$94 copayNot offered$94 copay
Tier 4: Non-Preferred Brand NameNot offereds$200 copayNot offered$200 copay
Tier 5: Specialty Tier
Tier 6: Select Care DrugsNot offereds$0 copayNot offered$0 copay
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds$0 copayNot offered$0 copay
Tier 2: Non-Preferred GenericNot offereds$60 copayNot offered$60 copay
Tier 3: Preferred Brand NameNot offereds$141 copayNot offered$141 copay
Tier 4: Non-Preferred Brand NameNot offereds$300 copayNot offered$300 copay
Tier 5: Specialty Tier
Tier 6: Select Care DrugsNot offereds$0 copayNot offered$0 copay

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain assessment
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder controlNot Rated
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Rating of health care quality
Rating of health plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept Health Net Seniority Plus Sapphire Premier II (HMO) for California

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Naeemah, Ghafur
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Rakhi, Sinha
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Mehrangiz, Cadry
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Gaston, Herrera
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John, Mull
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David, Noya
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Patrick, Lawrence
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Houman, Kashani
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Dennis, Bleakley
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Catherine, Rongey
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Edgar, Chavez
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Agustin, Lara
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David, Miller
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Amir, Goldkorn
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Monish, Aron
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Rogelio, Bravo
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Yvonne, Lin
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Giridharan, Ramsingh
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Casey, O'connell
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Richard, Jennelle
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Alan, Hiti
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Stephen, Liu
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Eric, Chang
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Julie, Lang
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Naeemah Ghafur, M.D.
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  • Phone Number
    (323) 234-5000
  • Office Locations
    2707 S Central Ave
    Los Angeles, CA 90011
2707 S Central Ave Los Angeles CA, 90011

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).

Medicare Plans Found

 

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).