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

Health Net California

HMO 40 NG Health Insurance Plan

A plan summary of the Health Net California HMO 40 NG Plan is detailed out below for both In Network and Out of Network coverage.

                                                In Network Out of Network



Not Applicable

  Office Visits

$40 Not Applicable

  Annual Deductible

Individual: $1,500 calendar year for inpatient hospital services only

Not Applicable

  Annual Out-Of-Pocket  Limit

Individual: $3,000 Family: $6,000

Not Applicable

  Lifetime Maximum

Unlimited Not Applicable

  Prescription Drugs

$100 Ded. then Generic: $15

Brand Formulary: $25

Non-Formulary: $50

Not Applicable

  Laboratory & X-Ray

No Charge Not Applicable

  Annual Physical Exam

No Charge Not Applicable

  Annual OB-GYN Exam

No Charge Not Applicable

  Well Baby Care

No Charge Not Applicable

  Outpatient Surgery

$250 Not Applicable

  Emergency Room

$100 (Waived if admitted) $100

  Inpatient Hospital

$1,500 inpatient hospital services deductible applies Only covered for Emergencies


$80 $80

  Home Health Care

$40 (See Brochure) Not Applicable

  Mental Health - Outpatient

$40 Not Applicable

  Chiropractic Care

See Brochure for Details Not Applicable


See Brochure for Details Not Applicable

  Mental Health - Inpatient

Not Applicable

  Chemical Dependency

$100 per day (Detox Only) Not Applicable

  Maternity Care

$1,500 inpatient hospital services deductible applies Not Applicable


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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