2019 Health Net Violet 3 (PPO) H5439-15-0 in OR from Health Net | HealthPocket

Health Net Violet 3 (PPO)

$0/mo

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Zip Code97229
Applicant12/11/1983 Male
Coverage Start12/12/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealth Net
Plan IDH5439-15-0
Plan Year2019
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$200.00

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

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$170 annual deductible
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,700 In and Out-of-network
$5,900 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$295 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
Out-of-Network:$475 per day for days 1 through 10
$0 per day for days 11 and beyond
Outpatient hospital coverageIn-Network:$300 per visit
Out-of-Network:$335 per visit
Doctor visitsPrimary:
In-Network:$20 per visit
Out-of-Network:$30 per visit
Specialist:
In-Network:$40 per visit
Out-of-Network:$50 per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$35-50 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:0-19%
Out-of-Network:0-20%
Lab services:
In-Network:$15
Out-of-Network:$20
Diagnostic radiology services (e.g., MRI):
In-Network:19%
Out-of-Network:20%
Outpatient x-rays:
In-Network:$18
Out-of-Network:$20
Mental health servicesInpatient hospital - psychiatric:
In-Network:$350 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-Network:$475 per day for days 1 through 10
$0 per day for days 11 through 190
Outpatient group therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:$50
Outpatient individual therapy visit with a psychiatrist:
In-Network:$40
Out-of-Network:$50
Outpatient group therapy visit:
In-Network:$40
Out-of-Network:$50
Outpatient individual therapy visit:
In-Network:$40
Out-of-Network:$50
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$170 per day for days 21 through 100
Out-of-Network:$0 per day for days 1 through 20
$220 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:$40
Out-of-Network:$50
Physical therapy and speech and language therapy visit:
In-Network:$40
Out-of-Network:$50
Ground ambulanceIn-Network:$380
Out-of-Network:$380
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$40
Out-of-Network:$50
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:19% per item
Out-of-Network:20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:19% per item
Out-of-Network:20% per item
Diabetes supplies:
In-Network:$0 copay
Out-of-Network:$0 or 20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:17%
Out-of-Network:20%
Other Part B drugs:
In-Network:17%
Out-of-Network:20%

Benefits Services

Hearing
Hearing examIn-Network: $30
Out-of-Network: $50
Fitting/evaluationNot covered
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Preventive Dental
Oral examNot covered
CleaningNot covered
Fluoride treatmentNot covered
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $10
Out-of-Network: $10
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0 copay
Out-of-Network: 20%
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: 20%
There may be limits on how much the plan will provide.
Eyeglass framesIn-Network: $0 copay
Out-of-Network: 20%
There may be limits on how much the plan will provide.
Eyeglass lensesIn-Network: $0 copay
Out-of-Network: 20%
There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for Health Net Violet 3 (PPO)

StateOregon
CountyMultnomah

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccineNot Rated
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical abilityNot Rated
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 fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
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 service
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 appealsNot Rated
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-forward
Appeals upheld

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 planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetesNot Rated
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rate Not Rated

Physicians that accept Health Net Violet 3 (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.