Changes ahead for Covered CA members in Health Net PPO

Health Net announced yesterday that the company is making significant changes to the California Individual and Family plan portfolio for 2015.  The changes are being made to help keep the cost of coverage more affordable for consumers, but Covered California members receiving a tax credit will see a significant change to provider access on their plans.

For 2015 Health Net will stop offering PPO plans inside Covered California and will replace those plans with EPO (Exclusive Provider Organization) plans.  Once approved, the new EPO plans will feature a smaller network of providers.  An EPO plan only pays for covered services if they’re received from a contracted provider (except for emergency situations.)  This means that members will no longer have access to out of network providers on their plans.

In addition, Health Net will no longer be offering plans in Mariposa, Monterey, and San Benito Counties through Covered California.  Consumers in these counties will be able to purchase Health Net “off exchange” or outside of Covered California.

Covered California members receiving a tax credit will be able to continue with a Health Net EPO plan and continue to apply the tax credit if they qualify financially.  But, Covered California members who wish to keep a larger network PPO plan will be unable to get a tax credit for 2015.  Instead, they’ll be forced to re-enroll in an off exchange Health Net PPO plan – or another carrier’s plan if they wish.

As a reminder, Open Enrollment for Individual and Covered California plans will run from November 15th to February 15th.

Current Health Net members are being notified of the changes beginning on October 2nd.  Members should watch their mail and email for additional notifications from both Health Net and Covered California.