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Home   >  Understanding Your Plan   >   Types of Plans   >   Prescriptions & Exclusions   >   Limitations & Exclusions
 
 

Health Net California

CFB Sensible NG 5200 Health Insurance Plan

A plan summary of the Health Net California CFB Sensible NG 5200 Plan is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network

  Copay

No Charge after Deductible

50%

  Office Visits

No Charge after Deductible 50%

  Annual Deductible

Individual: $5,200 Family: $10,400

Individual: $5,200 Family: $10,400

  Annual Out-Of-Pocket  Limit

Individual: $4,500 Family: $9,000 (Deductible included)

Individual: $5,000 Family: $10,000

( Deductible not Included)

  Lifetime Maximum

Unlimited Unlimited

  Prescription Drugs

No Charge after Medical / Rx Deductible

Not Covered

  Laboratory & X-Ray

No Charge after Deductible 50%

  Annual Physical Exam

No Charge (Deductible Waived) Not Covered

  Annual OB-GYN Exam

No Charge (Deductible Waived) Not Covered

  Well Baby Care

No Charge (Deductible Waived) Not Covered

  Outpatient Surgery

No Charge after Deductible 50%

  Emergency Room

No Charge after Deductible No Charge after Deductible

  Inpatient Hospital

No Charge after Deductible 50%

  Ambulance

No Charge after Deductible No Charge after Deductible

  Home Health Care

No Charge after Deductible 50%

  Mental Health - Outpatient

No Charge after Deductible Not Covered

  Chiropractic Care

No Charge after Deductible (12 visits per calendar year maximum)  50% (12 visits per calendar year maximum)

  Acupuncture

Not Covered Not Covered

  Chemical Dependency

No Charge after Deductible

(Detox only)

50% (Detox Only)

  Maternity Care

Not Covered Not Covered

                                                              


To learn more about your individual and family California health insurance options, the price of each plan and/or a detailed benefit summary of the plans, visit us here.

NOTICE! Final rates and benefits are based on actual plan selection (including plan riders you may request) and the assignment of any rate adjustment factors due to the health plan's underwriting guidelines.

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