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PPO Value 4500Health Net Logo

The PPO Value 4500 plan from Health Net of California features the following:

Plan Type: PPO
Deductible: $4,500
In-Patient Hospital Co-Payment/Coinsurance: $500
Prescription Drug Coverage (Out Patient): Yes
Maternity Coverage Included: $500 + 40%

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PPO Value 4500 Summary:

In Network Out of Network
Annual Deductible $4,500 $10,000
Annual Out-Of-Pocket Limit $2,500 (Does not include deductible) $5,000 (Does not include deductible)
Lifetime Maximum Unlimited Unlimited
Office Visits $35 for first 2 visits, 40% for 3+ visits 50%
Prescription Drugs $15 Generic $40 Brand $60 Non-Formulary Brand ($2,500 Brand Ded.) Not Covered
Laboratory and Radiology 40% 50%
Annual Physical Exam No Charge Not Covered
Annual OB-GYN Exam No Charge Not Covered
Well Baby Care No Charge Not Covered
Outpatient Surgery $500 per surgery plus 40% $500 per surgery plus 50% ($600 max per day)
Emergency Room $100 (waived if admitted) plus 40% $100 (waived if admitted) plus 40%
Ambulance 40% 40%
Home Health Care See Brochure See Brochure
Mental Health Services - Outpatient 40% Not Covered
Chiropractic Care Not Covered Not Covered
Acupuncture / Acupressure Not Covered Not Covered
Inpatient Hospital $500 per admit plus 40% $500 per admit plus 50% ($600 max per day)
Maternity Care $500 per admit plus 40% $500 per admit plus 50% ($600 max per day)
Mental Health - Inpatient $500 per admit plus 40% $500 per admit plus 50%
Chemical Dependency $500 plus 40% $500 per admit plus 50% ($600 max per day)


IMPORTANT NOTICE: Coinsurance amounts represented with a "%" are payable after the plan deductibles are reached; Co-pay amounts represented with a "$" are not subject to plan deductibles (except where noted). Refer to contract for a detailed explanation of plan benefits, features, exclusions and limitations. Benefits subject to change without notice. Out of pocket maximum shown includes the plan deductible unless otherwise noted. Co-pays, Deductibles, and Coinsurance amounts listed above are your share of the costs for covered benefits.

Do Not Cancel your current coverage until a new policy is approved and you have received written confirmation of the policy's rates and benefits from the insurance company. Rate and Benefit Disclaimer Notification!

Information contained in this website is limited in scope, subject to change without notice, and does not contain all the terms, conditions, limitations, or exclusions of the referenced benefit plans. Only the insurance company Plan Documents and Policy's contain the exact terms and conditions of coverage.



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