NON-MEDICARE PLANS

Health Net Blue & Gold HMO

This plan is an HMO (Health Maintenance Organization). You choose a primary care physician (PCP) who coordinates your care and refers you to specialists within your designated medical group.  The plan covers only the cost of services authorized by your PCP.  You pay a small copayment for prescription drugs and some services. HMOs provide coverage for services outside of your medical group only in cases of emergency.

Plan Highlights

• Has a custom network of providers created exclusively for UC, including
• All UC Medical Centers and medical groups
• 16 of the 20 largest provider groups serving current UC Health Net members
• Lower premiums than the standard Health Net HMO

In-network behavioral health benefits are provided by Optum (formerly United Behavioral Health)

Plan changes for 2013:

The following medical groups have been added to the Health Net Blue & Gold network:

• Affinity Medical Group – Eden/San Leandro (Alameda County)
• ARTA Health Network (Orange County)
• Memorial Care Medical Group (Orange County)
• Premier Physicians Network (Los Angeles County)
• Physicians Medical Group of San Jose (Santa Clara County)
• Vantage Medical Group (San Diego County)

The following medical groups have been removed from the Health Net Blue & Gold network:

• Brown and Toland (San Francisco County)
• Monarch (Orange County)

Copayments are increasing:

• Office visits: $20
• Urgent care: $20
• Outpatient surgery at hospital ambulatory surgery centers: $100
• Emergency room visits: $75
• Brand name prescription drugs: $25
• Non-formulary prescription drugs: $40

The copayment for smoking cessation drug is now $0.

Women’s preventive health services available at no cost (link to news item)

Retirees with family members in Medicare

If you or your family member(s) are enrolled in Medicare, you may still choose the Health Net Blue & Gold HMO for your family members not eligible for Medicare. For families with both Medicare and non-Medicare members, the Medicare-eligible family members will be in Health Net Seniority Plus.

 The family members enrolled in the Health Net Blue & Gold HMO will be able to transition to Health Net Seniority Plus when they become eligible for Medicare.