2018 Health Net Violet 2 (PPO) H5439-14-4 in WA from Health Net | HealthPocket

Health Net Violet 2 (PPO)

Medicare Advantage Plan for Washington

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Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealth Net
Plan IDH5439-14-4
CMS RatingNot Rated1
Plan TypePPO
Annual Deductible$150.00

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
  • was the 4th best selling plan in Clark in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$8,700 In and Out-of-network $6,700 In-network
Other health plan deductibles?
No
Health Plan Deductible
$215 annual deductible
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$375 for days 1 through 4
$0 for days 5 through 90
$0 for days 91 and beyond
Out-of-Network:
$500 for days 1 through 10
$0 for days 11 and beyond
Outpatient hospital coverage
In-Network:
$325 per visit
Out-of-Network:
$350 per visit
Doctor visits
Primary:
In-Network:
$15 per visit
Out-of-Network:
$30 per visit
Specialist:
In-Network:
$35 per visit
Out-of-Network:
$50 per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$35-50 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
0-20%
Out-of-Network:
0-25%
Lab services:
In-Network:
$18
Out-of-Network:
$20
Diagnostic radiology services (e.g., MRI):
In-Network:
20%
Out-of-Network:
25%
Outpatient x-rays:
In-Network:
$18
Out-of-Network:
$20
Mental health services
In-Network:
$375 for days 1 through 4
$0 for days 5 through 90
Out-of-Network:
$500 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 Facility
In-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 services
Occupational therapy visit:
In-Network:
$30
Out-of-Network:
$50
Physical therapy and speech and language therapy visit:
In-Network:
$30
Out-of-Network:
$50
Ambulance
In-Network:
$380
Out-of-Network:
$380
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$35
Out-of-Network:
$50
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
25% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
25% per item
Diabetes supplies:
In-Network:
$0 per item
Out-of-Network:
$0 or 25% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
18%
Out-of-Network:
25%
Other Part B drugs:
In-Network:
18%
Out-of-Network:
25%

Coverage Area for Health Net Violet 2 (PPO)

StateWashington
CountyKing

Cost Sharing Information

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
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

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Annual flu vaccine
Not Rated
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Not Rated
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
Reducing the risk of falling
Not Rated
Plan all-cause readmissions
Not Rated

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Not Rated
Customer service
Not Rated
Overall rating of health care quality
Not Rated
Overall rating of plan
Not Rated
Care Coordination
Not Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Not Rated
Members choosing to leave the health plan
Not Rated
Beneficiary access and performance problems
Not Rated
Health plan quality improvement
Not Rated

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Not Rated
Call center – foreign language interpreter and TTY/TDD availability - Medical
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
Appeals auto-forward
Not Rated
Appeals upheld
Not Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Not Rated
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Not Rated
Drug plan quality improvement
Not Rated

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs
Not Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
Not Rated
High risk medication
Not 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

Physician Finder

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

/
Globerman, Stacy
9800 4th Ave Ne
Seattle, WA 98115
Balogun, Anifat
6850 35th Ave Ne
Seattle, WA 98115
Tran, Thao
9725 3rd Ave Ne Ste 500
Seattle, WA 98115
Larson, Malorie
7315 212th St Sw
Edmonds, WA 98026
Newell, Stanley
9501 5th Ave Ne
Seattle, WA 98115
Simons, Bart
7209 Woodlawn Ave Ne
Seattle, WA 98115
Tilles, Stephen
9725 3rd Ave Ne Ste 500
Seattle, WA 98115
Kantor, Stanley
9208 Roosevelt Way Ne
Seattle, WA 98115
Lilja, Erik
9501 5th Ave Ne
Seattle, WA 98115
Naimi, David
9725 3rd Ave Ne Ste 500
Seattle, WA 98115
Smith, Catherine
7210 Roosevelt Way Ne
Seattle, WA 98115
Shamseldin, Shannon
7210 Roosevelt Way Ne
Seattle, WA 98115
Shamseldin, Michael
7210 Roosevelt Way Ne
Seattle, WA 98115
Sprenger, Jay
9725 3rd Ave Ne
Seattle, WA 98115
Mcgrew, Deborah
6300 9th Ave Ne
Seattle, WA 98115
Greaney, Ann
7210 Roosevelt Way Ne
Seattle, WA 98115
Doederlein, Susan
6300 9th Ave Ne
Seattle, WA 98115
Furukawa, Clifton
9725 3rd Ave Ne
Seattle, WA 98115
Langman, Alan
9714 3rd Ave Ne Suite 100
Renton, WA 98115
Szalay, Andrew
7210 Roosevelt Way Ne
Seattle, WA 98115
Clemens, Elizabeth
8028 35th Ave Ne
Seattle, WA 98115
Park, Audrey
9725 3rd Ave Ne Ste 500
Seattle, WA 98115
Kneisl, Alison
6300 9th Ave Ne
Seattle, WA 98115
Hamrick, Marcie
6300 9th Ave Ne
Seattle, WA 98115
Adams, Christine
6300 9th Ave Ne Ste 300
Seattle, WA 98115
Details
Stacy Globerman, M.D.
Phone Number
(206) 302-1200
Office Locations
9800 4th Ave Ne
Seattle, WA 98115
9800 4th Ave Ne Seattle WA, 98115

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