Health Net Rates Kaiser/Permanente Kaiser Rates - CEA
    Health Net Health Net   Traditional Kaiser HMO Kaiser Senior Advantage HMO     Kaiser 
    HMO PPO Oct 09 - Sep 10 Premium* Members Under 65 Medicare Part B Participants 2009-2010 Monthly Premium*   HMO
2010 Monthly Premium* Southern California Southern California Northen California Subscriber $644.00 $206.57     Southern CA Northern CA
Subscriber   $532.00 $627.00 $817.00 Subscriber+1 $1,287.00 $413.14 Subscriber   $517.00 $582.00
Subscriber + 1 $1,062.00 $1,302.00 $1,687.00 Subscriber + 2 or more $1,819.00 Not Available Subscriber + Spouse   $1,062.00 $1,202.00
Subscriber + 2 or more $1,452.00 $1,752.00 $2,302.00 Dependent/Student Coverage Dependent to age 19/Student age 25 Subscriber + Child(ren)   $912.00 $1,027.00
MEDICAL SERVICES   In Network Out of Network MEDICAL SERVICES     Subscriber + Family   $1,627.00 $1,852.00
Deductible         Deductible None None
~ Calendar Year Deductible Not Applicable $1500 / 3x family Calendar Year Deductible Not Applicable Not Applicable MEDICAL SERVICES  
Physician Services (Office Visits)       Physician Services     Deductible  
~ Office Visits   $30 Co-pay $20 Co-pay 40% Co-pay Primary and specialty care visits $10 Co-pay $20 Co-pay ~ Calendar Year Deductible Not Applicable
~ Specialist Visits $60 Co-pay $20 Co-pay 40% Co-pay Hearing tests $10 Co-pay $20 Co-pay Physician Services (Office Visits)  
~ Physical & Occupational Therapy $30 Co-pay 20% Co-pay 40% Co-pay X-ray and Lab Tests No Charge No Charge ~ Office Visits $30 Co-pay
~ Lab & X-ray   No Charge 20% Co-pay 40% Co-pay       ~ Specialist Visits $30 Co-pay
Maternity Care       Maternity Care     ~ Physical & Occupational Therapy $30 Co-pay
~ Prenatal & Postnatal Care $30 Co-pay 20% Co-pay 40% Co-pay Well-child preventive care $10 Co-pay $15 Co-pay ~ Lab & X-ray $10 Co-pay
~ Normal Delivery 20% Co-pay 20% Co-pay $500/admit + 40% Co-pay Scheduled prenatal care $10 Co-pay   Maternity Care    
~ Complications (Includes C Sections) 20% Co-pay 20% Co-pay 40% Co-pay       ~ Prenatal & Postnatal Care $10 Co-pay
Preventive Care       Preventive Care     ~ Normal Delivery $250 per admission
~ Well Women Exam $30 Co-pay $20 Co-pay Not Covered Routine Physical Exams $10 Co-pay $20 Co-pay ~ Complications (Includes C Sections) No Charge
~ Well Baby Care $30 Co-pay $20 Co-pay Not Covered Allergy injections/Immunization No Charge   Preventive Care    
~ Periodic Health Exam $30 Co-pay $20 Co-pay Not Covered       ~ Well Women Exam $30 Co-pay
Hospital Services       Hospital Services     ~ Well Baby Care $10 Co-pay
~ Inpatient Care $20 Co-pay 20% Co-pay $500/admit + 40% Co-pay Inpatient  No Charge No Charge ~ Periodic Health Exam $30 Co-pay
~ Outpatient Care $20 Co-pay  20% Co-pay $500/surgery + 40% Co-pay Outpatient No Charge $20 Co-payment Hospital Services    
~  Complex Radiology (CT, MRI, PET) $200 Co-pay  20% Co-pay 40% Co-pay Emergency Care     ~ Inpatient Care $250 per admission
~ Urgent Care   $30 Co-pay $20 Co-pay 40% Co-pay Ambulance No Charge No Charge ~ Outpatient Care $30 per procedure
~ Emergency Care       Emergency Room $35 Co-payment $20 Co-payment ~ Emergency Care    
  Ambulance $200 Co-pay $50 + 20% Co-pay $50 + 40% Co-pay   waived if admitted waived if admiited Ambulance   $150 Co-pay
  ER $200 Co-pay $100 + 20% Co-pay $100 + 40% Co-pay Mental Health Services     ER $150 Co-pay
  If admitted Waived $100 waived $100 waived Inpatient  No Charge No Charge If admitted Waived
Psychiatric Services         Outpatient $10 per visit   Psychiatric Services    
~ Inpatient Care (30 days/yr max) 20% Co-pay 20% Co-pay $500/admit + 40% Co-pay Outpatient Group Therapy visits $5 per visit   ~ Inpatient Care (30 days/yr max) $250 per admission
~ Outpatient Care - Crises Intervention $30 Co-pay $20 Co-pay 40% Co-pay       ~ Outpatient Care - Crises Intervention $30 / 20 visits
Alcohol/Chemical Dependency             Alcohol/Chemical Dependency    
~ Inpatient Care ( Detox Only ) 20% Co-pay 20% Co-pay 20% Co-pay Prescription Drugs     ~ Inpatient Care ( Detox Only ) $250 per admission
~ Outpatient Care $30 Co-pay 20% Co-pay 40% Co-pay  Generic $10 for 100 day supply $10 for 100 day supply ~ Outpatient Care $30 / 20 visits
Prescription Drugs       Brand $10 for 100 day supply $10 for 100 day supply Prescription Drugs    
~ Level I   $10 Co-pay $10 Co-pay $10 + 50% Co-pay Annual Maximum Unlimited Unlimited ~ Generic $10 for up to a 30 day supply
~ Level II   $25 Co-pay $35 Co-pay $35+ 50% Co-pay       ~ Brand Name $20 for up to a 30 day supply
~ Level III   $50 Co-pay $50 Co-pay $50 + 50% Co-pay Additional Benefits     Additional Benefits    
~ Mail Order   90 day for 2x Co-pay 90 day for 2x Co-pay Not Covered Skilled nursing facility No Charge   ~ Durable Medical Equipment   50% Coinsurance
Additional Benefits       Hospice Care/Home care No Charge No Charge Out of Pocket Maximums    
~ Durable Medical Equipment No Charge ($2k/yr max benefit) 20% ($2k/yr max benefit) 40% ($2k/yr max benefit) Vision Care     ~ One Member $3,000
~ Diabetic Supplies No Charge 20% Co-pay 40% Co-pay Eye Exam $10 Co-payment $20 Co-pay ~ Two Members or more   $6,000
Out of Pocket Maximums       Lenses Not Covered No Charge - every 24 months Preexisiting Conditions Covered
~ One Member $3,500 $3,000 $6,000 Frames Not Covered $150 allowance - every 24 months        
~ Two Members $7,000 $6,000 $12,000 Contact Lenses     * Contract Renewal November 1, 2010.
~ Family   $7,000 $9,000 $18,000 Elective Not Covered Not Covered
Preexisiting Conditions Covered Not Covered for 6 months without prior coverage Medically Needed Not Covered $150 allowance - every 24 months
* Contract Renewal/Open Enrollment January 1, 2010. Out of Pocket Maximums $1500 per member, $3000 per family  
Amount in excess of $150   Eyewear purchased 
Preexisiting Conditions Covered Covered
*Contract Renewal October 1, 2010
As of 12/01/09 These are only a summary of benefits.  Please consult contract for complete descriptions of benefits, exclusions, and participating requirements