2018 Health Net Violet 2 (PPO) H5439-14-2 in OR from Health Net | HealthPocket

Health Net Violet 2 (PPO)

$24/mo

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Zip Code97229
Applicant12/14/1983 Male
Coverage Start12/15/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealth Net
Plan IDH5439-14-2
Plan Year2018
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$150.00

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan

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

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$6,600 In and Out-of-network $5,100 In-network
Other health plan deductibles?No
Health Plan Deductible$215 annual deductible
Monthly Drug Plan Premium$24.00
Monthly Health Plan Premium$0.00

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:
$325 for days 1 through 4
$0 for days 5 through 90
$0 for days 91 and beyond
Out-of-Network:
$450 for days 1 through 10
$0 for days 11 and beyond
Outpatient hospital coverageIn-Network:
18% per visit
Out-of-Network:
30% per visit
Doctor visitsPrimary:
In-Network:
$15 per visit
Out-of-Network:
$30 per visit
Specialist:
In-Network:
$30 per visit
Out-of-Network:
$50 per visit
Preventive careIn-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$35-50 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:
0-18%
Out-of-Network:
0-30%
Lab services:
In-Network:
$20
Out-of-Network:
$25
Diagnostic radiology services (e.g., MRI):
In-Network:
18%
Out-of-Network:
30%
Outpatient x-rays:
In-Network:
$20
Out-of-Network:
$25
Mental health servicesIn-Network:
$325 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
$450 for days 1 through 10
$0 for days 11 through 190
Outpatient group therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
$50
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
$50
Outpatient group therapy visit:
In-Network:
$30
Out-of-Network:
$50
Outpatient individual therapy visit:
In-Network:
$30
Out-of-Network:
$50
Skilled Nursing FacilityIn-Network:
$0 for days 1 through 20
$150 for days 21 through 100
Out-of-Network:
$0 for days 1 through 20
$200 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:
$30
Out-of-Network:
$50
Physical therapy and speech and language therapy visit:
In-Network:
$30
Out-of-Network:
$50
AmbulanceIn-Network:
$325
Out-of-Network:
$325
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:
$30
Out-of-Network:
$50
Routine foot care:
Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
18% per item
Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
18% per item
Out-of-Network:
30% per item
Diabetes supplies:
In-Network:
$0 per item
Out-of-Network:
$0 or 30% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:
17%
Out-of-Network:
30%
Other Part B drugs:
In-Network:
17%
Out-of-Network:
30%

Coverage Area for Health Net Violet 2 (PPO)

StateOregon
CountyMultnomah

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


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$5 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$15 copay$20 copayNot offered
Tier 3: Preferred Brand Name$37 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$90 copay$100 copayNot offered
Tier 5: Specialty Tier30% coinsurance30% coinsuranceNot offered

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$10 copay$20 copayNot offered
Tier 2: Non-Preferred Generic$30 copay$40 copayNot offered
Tier 3: Preferred Brand Name$74 copay$94 copayNot offered
Tier 4: Non-Preferred Brand Name$180 copay$200 copayNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$15 copay$30 copayNot offered
Tier 2: Non-Preferred Generic$45 copay$60 copayNot offered
Tier 3: Preferred Brand Name$111 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$270 copay$300 copayNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screeningNot Rated
Colorectal cancer screening
Annual flu vaccineNot Rated
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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis managementNot Rated
Reducing the risk of fallingNot Rated
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed care
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forwardNot Rated
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Health Net Violet 2 (PPO) for Oregon

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Webber, Marilyn
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Hardebeck, Laura
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Finn, Katherine
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Miller, Jewel
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Dalmia, Lopa
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Blievernicht, Matthew
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Simas, Gilbert
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Chiang, Lydia
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Barich, Frank
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Kakodkar, Swati
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Dorrington, Michael
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Pena, Angeles
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Mcilraith, Marlo
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Samagh, Gunjeet
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Barlow, Robert
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Barry, Harold
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Geddes, Gary
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Doshi, Heena
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Krisciunas, Vic
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Losli, Steve
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Gillingham, Todd
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Crihfield, Kimberly
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Hankenson, Lori
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Marilyn Webber, M.D.
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  • Phone Number
    (503) 629-0237
  • Office Locations
    14223 Nw Spruceridge Ln
    Portland, OR 97229
14223 Nw Spruceridge Ln Portland OR, 97229
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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual 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.