Health Net Modifying Exchange/Mirror Products November 4, 2014 Covered California, Physician Resource Covered California, health insurance exchange, Health Net, PureCare One 0 Health Net recently announced changes to its exchange/mirror products offered for 2015. In a notice mailed to select physicians, Health Net said it will be offering an Exclusive Provider Organization (EPO) and a Health Care Service Plan (HSP) for its individual exchange/mirror products effective January 1, 2015. No PPO product offered in the individual exchange/mirror market. The EPO will be called PureCare One and the HSP will be called PureCare. Patients will be able to select one of these new plans during the next Covered California open enrollment period, which begins November 15. Both of the new products will utilize a narrowed provider network. The new EPO and HSP products function similar to an HMO in that they do not offer out of network benefits. Additionally, individuals who select the PureCare HSP will be required to select a primary care physician (PCP). The Purecare One EPO plan, however, does not require individuals to select a PCP. Health Net will offer the PureCare One EPO product in all Bay Area counties (Marin, San Francisco, Contra Costa, Santa Clara, and San Mateo). In addition to the above changes for the individual market, Health Net has advised that it will begin offering the EPO product along with the PPO product in the SHOP market, which is offered in all counties. Physicians who received the notice were also advised that they were automatically being opted into the provider networks for Health Net’s new products and will be paid at 100% of their current contracted PPO/EPO rates. Practices who did not receive the notice are encouraged to confirm their participation status with Health Net by calling Provider Services at (800) 641-7761 as Health Net’s online directory had not been updated to reflect the new products at the time of publication. Health Net has advised that it will still offer the individual PPO product, however individuals who select that product will not be eligible to receive Covered California premium subsidies. Practices with questions about the notice can contact Health Net Provider Services Center at (800) 641-7761. Comments are closed.
