Renewal Guide. Commercial. Small Group 2.0 for California Small Business Group

Transcription

1 Commercial California Small Business Group Health Net of California, Inc. and Health Net Life Insurance Company (Health Net) Renewal Guide Small Group 2.0 for 2018

2 What s New in Small Group 2.0 Plans to take your business forward Lower-priced HMOs Offer the benefits your employees value at a cost that s good for your business with three new, lower-priced HMO plans. More PPO plan choices and price points Three new PPO plan designs complement our Value and Standard plans. Why we re excited: Lower price than our Standard plans. Separate medical/rx deductibles make prescriptions more affordable! New tailored network PPO for Los Angeles EnhancedCare PPO is a more affordable PPO for L.A. that combines the choice and flexibility of a PPO with the supportive structure of an HMO. Pick your plan, pick your network Pick your favorite plan design; then pair it with any of the networks we offer in your location. Now featuring the new Platinum $30 and Gold $35 HMOs, and our trio of new PPOs! Nichole dalomba, Health Net We deliver performance as promised. More points of care Virtual doctor visits via Teladoc for CommunityCare HMO and EnhancedCare PPO members. In-home doctor visits via Heal for Full Network PPO and EnhancedCare PPO members. Note: PureCare One EPO plans closed, effective January 1, We continue to offer PureCare HSP plans in metal levels.

3 Table of Contents Small Group 2.0 for Portfolio Highlights... 4 Pick Your Plan, Pick Your Network... 5 Enhanced Choice Packages Changes and Additions PPO Plan-to-Plan Crosswalk of Benefit Changes... 8 Choices by Location Benefit Overview by Plan Type Underwriting Guideline Summary Understanding Rates Ancillary Programs Health Net Dental Health Net Vision Chiropractic Care Life and Accidental Death & Dismemberment Rate Guide More Than an ID Card Decision Power : Health & Wellness Focus on early access and prevention Health Net online and on the go Group Administration Employee additions, changes and more...40 Online billing and enrollment...42 Appendix/Forms Contact Us... Back cover

4

5 Small Group 2.0 for 2018 Simplified, Sustainable, Small Business-Focused Questions? Need more information? Please contact Health Net Account Management at , option 2. 3

6 2018 Portfolio Highlights Simplified. Sustainable. Small business-focused. Renew by the 18th! The 18th of the month is the last day to submit plan changes for accurate processing and billing for your renewal date. If you submit changes after the 18th, expect retroactive billing adjustments, another set of ID cards and claims re-adjudication. Lower-priced HMO plans The addition of three new, lower-priced HMO plans gives you rich coverage at a lower price (compared to our other plans in these metal tiers). Platinum $30, Gold $35 and Silver $40 give you more ways to find the right mix of coverage and cost. CommunityCare HMO expands to San Diego County CommunityCare HMO has expanded to San Diego County (pending regulatory approval). Now employers in Los Angeles, Orange and San Diego counties can offer CommunityCare HMO in Gold, Silver tiers. More PPO choices Choose from three new Alternate plans that expand our PPO offerings at price points that complement Value and Standard plans. New! Our new PPOs Platinum, Gold and Silver offer lower price points than our Standard plans and no integrated medical/ Rx deductible like our Value plans. Full Network PPO Silver High Deductible Health Plan (HDHP) is now an option in all regions and available on- and off-exchange. Full Network PPO Health Savings Account (HSA) plans were renamed High Deductible Health Plans (HDHP). They have the same benefit design as EnhancedCare PPO: A more affordable PPO for L.A. EnhancedCare PPO gives members advantages of PPO and HMO coverage combining the choice and flexibility of a PPO with the care navigation and support of an HMO. By bringing a tailored network design to the PPO experience, EnhancedCare PPO is a more affordable PPO option. More care choices, including virtual doctor visits and house calls, support workplace productivity. Health Benefit Navigator team helps members choose services and use coverage. Tailored network offers a curated selection of provider groups and hospitals near where members live. Plus, now you can choose either the tailored EnhancedCare or the Full PPO Network for any PPO plan design. 4

7 Pick Your Plan, Pick Your Network Choose your favorite plan design and pair it with any of the networks we offer in your location as shown below. The plan design stays the same. Simple. The addition of Platinum $30 and Gold $35 HMOs, and three new PPOs gives you more flexibility and ways to find the perfect fit. HMO Step 1: Pick your plan design. Step 2: Pair your plan with any of the networks we offer in your location. Platinum $10 Full Network $$$ $ Platinum $20 Platinum $30 Gold $30 Gold $35 Gold $40 Silver $40 Network size WholeCare SmartCare Salud HMO y Más New mix-and-match option for L.A. employers who prefer PPOs. PPO Step 1: Pick your plan design. Step 2: Pair your plan with the network that fits and is available in the group s location. Platinum 250/15 Full PPO Network $$$ $ Gold 1000/30 Gold Value Silver 2000/55 Silver Value Silver HDHP Bronze HDHP Network size EnhancedCare PPO Network CommunityCare HMO Small Group 2.0 continues to offer CommunityCare HMOs to employers in Los Angeles, Orange and San Diego counties. Available from Health Net of California, Inc., these HMO designs Gold, Silver come with the tailored CommunityCare HMO Network and feature low premiums. 5

8 Enhanced Choice Health Net invites you to be choosy! With Enhanced Choice, you have the option to offer multiple plans to your employees. First, decide on the package you d like: Enhanced Choice A or Enhanced Choice B. Then you can offer any number or combination of plans which are within that package and available in your location. Two packages that offer multiple plans Enhanced Choice A Enhanced Choice B Full Network HMO Full Network HMO WholeCare HMO WholeCare HMO SmartCare HMO SmartCare HMO Salud HMO y Más Salud HMO y Más CommunityCare HMO CommunityCare HMO PureCare HSP PureCare HSP Full Network PPO EnhancedCare PPO Full Network PPO Bronze Whether you go for Enhanced Choice A or Enhanced Choice B, the setup works the same! Enhanced Choice A Participation Requirements The Enhanced Choice A package is available statewide. How it works 1 5 eligible employees eligible employees + 66% employee participation minimum + 50% employee participation minimum + Employer pays minimum of 50% of base plan monthly or Employer pays a minimum of $100 per employee toward the employee-only rate = Access to Health Net s Enhanced Choice A portfolio Enhanced Choice B Participation Requirements The Enhanced Choice B package is available statewide and comes with relaxed participation for groups with employees. In regions 15 and 16, EnhancedCare PPO is a plan option. How it works 1 5 eligible employees eligible employees + 66% employee participation minimum + 35% employee participation minimum + Employer pays minimum of 50% of base plan monthly or Employer pays a minimum of $100 per employee toward the employee-only rate = Access to Health Net s Enhanced Choice B portfolio Skip the paperwork with Enhanced Choice B! Enroll a minimum of 6 active subscribers Enroll a minimum of 10 active subscribers for groups of 6 or more eligible employees, for groups of 10 or more eligible employees, and we ll accept a prior carrier bill in lieu of and there s no DE 9C, payroll or prior a DE 9C. carrier bill. 6

9 2018 Changes and Additions Notice of Changes to Coverage Terms Commercial Small Business Group plan contracts will contain updates as shown in the Notice of Changes to Coverage Terms document. For details on the benefit or coverage modifications, log in to For more information, please contact Health Net Account Management. Plan and network availability vary by county. See Choices by Location for plans by region. Advanced Choice Pharmacy Network is our first tailored pharmacy network. It pairs with CommunityCare HMO, SmartCare HMO, Salud HMO y Más, and EnhancedCare PPO. This network includes CVS, Walmart, Costco, Safeway, Vons, and other pharmacies. Walgreens is excluded. HMO Plan Tailored HMO plan designs can be paired with a choice of the SmartCare HMO, WholeCare HMO or Salud HMO y Más networks. These plan designs are also available with Full Network HMO! Platinum $10 Gold $30 Silver $40 Platinum $20 Gold $35 Platinum $30 Gold $40 CommunityCare HMO HMO Gold $5 HMO Silver $20 HMO Bronze $45 Full Network PPO EnhancedCare PPO Platinum 90 PPO 0/15 + Child Dental Platinum 90 PPO 250/15 + Child Dental Alt Gold 80 PPO 0/25 + Child Dental Gold 80 PPO 1000/30 + Child Dental Alt Gold 80 Value PPO 750/10 + Child Dental Alt Silver 70 PPO 2000/45 + Child Dental Silver 70 PPO 2000/55 + Child Dental Alt Silver 70 Value PPO 1700/30 + Child Dental Alt Silver 70 HDHP 1350/40 PPO + Child Dental Alt Bronze 60 PPO 6300/75 + Child Dental Bronze 60 HDHP 5600/15 PPO + Child Dental Alt Platinum 90 EnhancedCare PPO 250/15 + Child Dental Alt Gold 80 EnhancedCare PPO 1000/30 + Child Dental Alt PPO Gold Value PPO Silver Value Silver 70 EnhancedCare PPO 2000/55 + Child Dental Alt PureCare HSP Platinum 90 HSP 0/15 Silver 70 HSP 2000/45 Gold 80 HSP 0/25 Bronze 60 HSP 6300/75 Silver 70 HDHP 1350/40 EnhancedCare PPO + Child Dental Alt Bronze 60 HDHP 5600/15 EnhancedCare PPO + Child Dental Alt Health Net HMO and HSP health plans are offered by Health Net of California, Inc. Health Net PPO insurance plans are underwritten by Health Net Life Insurance Company. Changes to grandfathered PPO plans As of January 1, 2018, California Senate Bill 374 (CA SB 374) requires small group PPO health insurance policies to cover all mental health and substance use disorder benefits in compliance with those provisions of federal law governing the Mental Health Parity and Addiction Equity Act (MHPAEA). In order to comply with CA SB 374, and minimize the impact to employees who have PPO coverage, we will move employees to a CA SB 374-compliant plan upon your renewal. This legislative modification will not impact the plan s grandfathered status. 7

10 2018 PPO Plan-to-Plan Crosswalk of Benefit Changes Platinum 90 PPO 0/15 + Child Dental (Standard) Benefit changes for services provided by in-network (preferred) providers Out-of-pocket maximum decreased from $4,000 individual/$8,000 family to $3,350 individual/$6,700 family. Specialist visit decreased from a $40 copayment to a $30 copayment per visit. Laboratory tests decreased from a $20 copayment to a $15 copayment. X-rays and diagnostic imaging decreased from a $40 copayment to a $30 copayment. Gold 80 PPO 0/30 + Child Dental to Gold 80 PPO 0/25 + Child Dental (Standard) Benefit changes for services provided by in-network (preferred) providers Out-of-pocket maximum decreased from $6,750 individual/$13,500 family to $6,000 individual/$12,000 family. Primary care visit decreased from a $30 copayment to a $25 copayment per visit. Urgent care visit decreased from a $30 copayment to a $25 copayment per visit. Outpatient rehabilitation and habilitation services decreased from a $30 copayment to a $25 copayment per visit. Silver 70 PPO 2000/45 + Child Dental (Standard) Benefit changes for services provided by in-network (preferred) providers Pharmacy deductible revised from $250 individual/$500 family to $125 individual/$250 family and applies to tier 1 drugs in addition to tiers 2 4. Out-of-pocket maximum increased from $6,800 individual/$13,600 family to $7,000 individual/$14,000 family. Bronze 60 PPO 6300/75 + Child Dental (Standard) Benefit changes for services provided by in-network (preferred) providers Out-of-pocket maximum increased from $6,800 individual/$13,600 family to $7,000 individual/$14,000 family. PPO Gold Value (2017) to Gold 80 Value PPO 750/10 + Child Dental Alt (2018) No cost-share changes. PPO Silver Value (2017) to Silver 70 Value PPO 1700/30 + Child Dental Alt (2018) No cost-share changes. Health Net PPO insurance plans are underwritten by Health Net Life Insurance Company. Health Net Life Insurance Company is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved. 8

11 PPO Bronze HSA (2017) to Bronze 60 HDHP 5600/15 PPO + Child Dental Alt (2018) No cost-share changes. PPO Silver HSA (2017) to Silver 70 HDHP 1350/40 PPO + Child Dental Alt (2018) Benefit changes for services provided by in-network (preferred) providers Deductible increased from $1,300 individual/$2,600 family to $1,350 individual/$2,700 family. Benefit changes for services provided by out-of-network (non-preferred) providers Deductible increased from $2,600 individual/$5,200 family to $2,700 individual/$5,400 family. EnhancedCare PPO Gold Value No cost-share changes. EnhancedCare PPO Silver Value No cost-share changes. EnhancedCare PPO Bronze HSA (2017) to Bronze 60 HDHP 5600/15 EnhancedCare PPO + Child Dental Alt (2018) No cost-share changes. EnhancedCare PPO Silver HSA (2017) to Silver 70 HDHP 1350/40 EnhancedCare PPO + Child Dental Alt (2018) Benefit changes for services provided by in-network (preferred) providers Deductible increased from $1,300 individual/$2,600 family to $1,350 individual/$2,700 family. Benefit changes for services provided by out-of-network (non-preferred) providers Deductible increased from $2,600 individual/$5,200 family to $2,700 individual/$5,400 family. Certification requirements update Cardiac catheterization and behavioral health treatment for pervasive developmental disorder or autism no longer require certification. All durable medical equipment, prostheses and physical therapy now require certification. In addition, balloon sinuplasty; capsule endoscopy; injections for intended use of steroid and/or pain management, including epidural, nerve, nerve root, facet joint, trigger point, and sacroiliac (SI) joint injection; spinal surgery; and penile implant also require certification. Clarification made to outpatient pharmaceutical items to refer to the formulary to identify specific drugs that require prior authorization. 9

12 Choices by Location Region We offer In this metal tier With this network Region 1 Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, and Yuba counties PPO Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Nevada County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare Region 2 Marin, Napa, Solano, and Sonoma counties Region 3 Sacramento, Placer, El Dorado, and Yolo counties HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 4 San Francisco County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO Platium, Gold, Silver, PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 5 Contra Costa County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO 10

13 Region We offer In this metal tier With this network Region 6 Alameda County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 7 Santa Clara County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 8 San Mateo County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 9 Santa Cruz County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Monterey and San Benito counties HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO PPO Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 10 Mariposa County PPO San Joaquin, Stanislaus, Merced, and Tulare counties Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO 11

14 Region We offer In this metal tier With this network Region 11 Fresno, Kings and Madera counties Region 12 Santa Barbara and Ventura counties HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO San Luis Obispo County PPO Region 13 Mono, Inyo and Imperial counties Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO PPO Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 14 Kern County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare Salud y Más Region 15 Los Angeles County: ZIP codes starting with , 915, 917, 918, 935 HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Salud y Más HSP Gold, Silver, Bronze CommunityCare PureCare PPO Platinum, Gold, Silver Your choice of: Full Network PPO EnhancedCare PPO Bronze Full Network PPO PPO Value Gold, Silver Your choice of: PPO HDHP Silver, Bronze Full Network PPO EnhancedCare PPO 12

15 Region We offer In this metal tier With this network Region 16 Los Angeles County: ZIP codes not in Region 15 HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Salud y Más Region 17 San Bernardino and Riverside counties HSP Gold, Silver, Bronze CommunityCare PureCare PPO Platinum, Gold, Silver Your choice of: Full Network PPO EnhancedCare PPO Bronze Full Network PPO PPO Value Gold, Silver Your choice of: PPO HDHP Silver, Bronze Full Network PPO EnhancedCare PPO HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Salud y Más HSP PPO PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 18 Orange County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Salud y Más HSP PPO Gold, Silver, Bronze CommunityCare PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO Region 19 San Diego County HMO Platinum, Gold, Silver Your choice of: Full Network WholeCare SmartCare Salud y Más HSP PPO Gold, Silver, Bronze CommunityCare PureCare Full Network PPO PPO Value Gold, Silver Full Network PPO PPO HDHP Silver, Bronze Full Network PPO 13

16 Plan name Deductible (single / family) Out-of-pocket maximum (single / family) Office / Specialist visit California Small Group Portfolio Lab / X-rays Member(s) responsibility Outpatient surgery (ASC / hospital) Inpatient hospital Emergency room facility Urgent care Rx brand deductible Pharmacy Rx drug tier 1 / 2 / 3 / 4 Full HMO, WholeCare HMO, SmartCare HMO, and Salud HMO y Más 1 Available through Health Net of California, Inc. Platinum $10 None $2,000 / $4,000 $10 / $30 $10 / $10 $40 / $100 $300 per admission $100 $30 $0 $5 / $30 / $50 / 30% 2 Platinum $20 None $3,000 / $6,000 $20 / $40 $10 / $10 $200 / $500 $700 per admission $150 $40 $0 $5 / $30 / $50 / 30% 2 Platinum $30 None $2,250 / $4,500 $30 / $50 $20 / $50 $150 / $150 $500 per day (4-day max copay per admission) $250 $30 $0 $5 / $20 / $30 / 30%2 Gold $30 None $5,000 / $10,000 $30 / $50 $40 / $40 $360 / $900 $1,200 per admission $300 $50 $0 $15 / $50 / $70 / 30%2 Gold $35 None $6,000 / $12,000 $35 / $55 $40 / $50 $480 / $1,200 $750 per day (3-day max copay per admission) $300 $55 $0 $15 / $50 / $70 / 30%2 Gold $40 None $6,000 / $12,000 $40 / $60 $40 / $40 $440 / $1,100 $1,300 per admission $300 $60 $0 $15 / $50 / $70 / 30%2 Silver $40 None $7,200 / $14,400 $40 / $60 $40 / $50 40% / 50% $750 per day (3-day max copay per admission) 50% $60 $250 $20 / 50% / 50% / 50%2 CommunityCare HMO 1 Available through Health Net of California, Inc. Gold $5 $1,500 / $3,000 $6,000 / $12,000 1st visit: $0 3 / $30 3 Visit 2+: $5 3 / $30 3 $10 3 / $ % / 30% 30% $150 $30 3 $0 $5 / $40 / $60 / 30% 2 Silver $20 $2,000 / $4,000 $7,250 / $14,500 1st visit: $0 3 / $45 3 Visit 2+: $20 3 / $45 3 $40 / $50 40% / 50% 50% $300 $45 3 $150 $10 / $50 / $60 / 50% 2 Bronze $45 $3,750 / $7,500 $7,350 / $14,700 $45 / $60 50% / 50% 50% / 50% 50% 50% $60 $3,750 / $7,500 Integrated medical Rx deductible $15 3 / $50 / 50% / 50% 4 Plan name Deductible (single / family) Out-of-pocket maximum Coinsurance (single / family) Office / Specialist visit Member(s) responsibility Lab / X-rays PPO 1 Available through Health Net Life Insurance Company and Covered California TM Platinum 90 PPO 0/15 + Child Dental Platinum 90 PPO 250/15 + Child Dental Alt Gold 80 PPO 0/25 + Child Dental Gold 80 PPO 1000/30 + Child Dental Alt 5 Gold 80 Value PPO 750/10 + Child Dental Alt Silver 70 PPO 2000/45 + Child Dental Silver 70 PPO 2000/55 + Child Dental Alt 5 Silver 70 Value PPO 1700/30 + Child Dental Alt Silver 70 HDHP 1350/40 PPO + Child Dental Alt Outpatient surgery (ASC / hospital) Inpatient hospital Emergency Urgent room care facility Rx deductible (single / family) Pharmacy Rx drug tier 1 / 2 / 3 / 4 None $3,350 / $6,700 10% $15 / $30 $15 / $30 10% / 10% 10% $150 $15 $0 $5 / $15 / $25 / 10% 2 $250 / $500 $3,600 / $7,200 10% $15 3 / $30 3 $30 3 / $ % / 10% 10% 10% $30 3 $0 $5 / $30 / $50 / 10% 2 None $6,000 / $12,000 20% $25 / $55 $35 / $55 20% / 20% 20% $325 $25 $0 $15 / $55 / $75 / 30% $1,000 / $2,000 $750 / $1,500 $2,000 / $4,000 $2,000 / $4,000 $1,700 / $3,400 $1,350 / $2,700 October 2018 $7,200 / $14,400 30% $30 3 / $50 3 $30 3 / $ % / 30% 30% 30% $50 3 $0 $15 / $30 / $50 / 30% 2 $7,150 / $14,300 30% $10 3 / $30 $20 / $20 20% / 30% 30% $250 $30 $750 / $1,500 Integrated med / Rx deductible $10 3 / $25 / $50 / 30% 2 $7,000 / $14,000 20% $45 3 / $75 3 $40 3 / $ % 3 / 20% 3 20% $350 3 $45 3 $125 / $250 $15 / $55 / $85 / 20% 2 All drug deductible $7,350 / $14,700 40% $55 3 / $75 3 $40 3 / $ % / 40% 40% 40% $75 3 $300 / $600 $15 3 /$65 / $85 / 40% 2 $7,150 / $14,300 40% $30 3 / $75 $50 / $50 30% / 40% 40% $300 $75 $1,700 / $3,400 Integrated med / Rx deductible $15 3 / $55 / $85 / 40% 2 $6,550 / $13,100 30% $40 / $60 30% / 30% 20% / 30% 30% 30% $60 $1,350 / $2,700 $19 / $40 / $60 / 30% 2 Integrated med / Rx all drug deductible (continued) 14

17 Plan name Bronze 60 PPO 6300/75 + Child Dental Bronze 60 HDHP 5600/15 PPO + Child Dental Alt Deductible (single / family) $6,300 / $12,600 $5,600 / $11,200 Out-of-pocket maximum Coinsurance (single / family) Office / Specialist visit Member(s) responsibility Lab / X-rays Outpatient surgery (ASC / hospital) Inpatient hospital Emergency Urgent room care facility Rx deductible (single / family) 6 $7,000 / $14, % 6 $75 7 / $105 7 $40 3 / 100% 6 100% / 100% 6 100% 100% $75 $500 / $1,000 All drug deductible $6,550 / $13,100 20% $15 / $30 20% / 20% 10% / 20% 20% 20% $30 $5,600 / $11,200 Integrated med / Rx all drug deductible EnhancedCare PPO Available through Health Net Life Insurance Company and Covered California TM Pharmacy Rx drug tier 1 / 2 / 3 / 4 100% 8 $5 / $15 / $40 / 20% 4 Platinum 90 EnhancedCare PPO 250/15 + Child Dental Alt $250 / $500 $3,600 / $7,200 10% $15 3 / $30 3 $30 3 / $ % / 10% 10% 10% $30 3 $0 $5 / $30 / $50 / 10%2 $7,200 / $14,400 30% $30 3 / $50 3 $30 3 / $ % / 30% 30% 30% $50 3 $0 $15 / $30 / $50 / 30%2 Gold 80 EnhancedCare PPO 1000/30 + Child Dental Alt $1,000 / $2,000 EnhancedCare PPO Gold Value 5 $750 / $1,500 Silver 70 EnhancedCare PPO 2000/55 Child Dental Alt $2,000 / $4,000 EnhancedCare PPO Silver Value 5 $1,700 / $3,400 Silver 70 HDHP 1350/40 EnhancedCare PPO + Child Dental Alt Bronze 60 HDHP 5600/15 EnhancedCare PPO + Child Dental Alt $1,350 / $2,700 $5,600 / $11,200 $7,150 / $14,300 30% $103 / $30 $20 / $20 20% / 30% 30% $250 $30 $750 / $1,500 Integrated med / Rx deductible $103 / $25 / $50 / 30% $7,350 / $14,700 40% $55 3 / $75 3 $40 3 / $ % / 40% 40% 40% $75 3 $300 / $600 $153 / $65 / $85 / 40%2 $7,150 / $14,300 40% $30 3 / $75 $50 / $50 30% / 40% 40% $300 $75 $1,700 / $3,400 Integrated med / Rx deductible $6,550 / $13,100 30% $40 / $60 30% / 30% 20% / 30% 30% 30% $60 $1,350 / $2,700 Integrated med / Rx deductible $6,550 / $13,100 20% $15 / $30 20% / 20% 10% / 20% 20% 20% $30 $5,600 / $11,200 Integrated med / Rx all drug deductible PureCare HSP 1 Available through Health Net of California, Inc. Platinum 90 HSP 0/15 $153 / $55 / $85 / 40% $19 / $40 / $60 / 30% $5 / $15 / $40 / 20% None $3,350 / $6,700 10% $15 / $30 $15 / $30 10% / 10% 10% $150 $15 $0 $5 / $15 / $25 / 10%2 Gold 80 HSP 0/25 None $6,000 / $12,000 20% $25 / $55 $35 / $55 20% / 20% 20% $325 $25 $0 $15 / $55 / $75 / 20%2 Silver 70 HSP 2000/45 Bronze 60 HSP 6300/75 $2,000 / $4,000 $6,300 / $12,600 $7,000 / $14,000 20% $45 3 / $75 3 $40 3 / $ % 3 / 20% 3 20% $3503 $45 3 $125 / $250 $15 / $55 / $85 / 20%2 $7,000 / $14, %6 $75 7 / $105 7 $40 3 / 100% 6 100% 6 / 100% 6 100% 6 100% 6 $75 7 $500 / $1, %8 (continued) 15

18 Two packages that offer multiple plans Enhanced Choice A Full Network HMO WholeCare HMO SmartCare HMO Salud HMO y Más CommunityCare HMO PureCare HSP Full Network PPO Enhanced Choice A Participation Requirements The Enhanced Choice A package is available statewide. How it works 1 5 eligible employees eligible employees + 66% employee participation minimum + 50% employee participation minimum + Employer pays minimum of 50% of base plan monthly or Employer pays a minimum of $100 per employee toward the employee-only rate = Access to Health Net s Enhanced Choice A portfolio Enhanced Choice B Full Network HMO WholeCare HMO SmartCare HMO Salud HMO y Más CommunityCare HMO PureCare HSP EnhancedCare PPO Full Network PPO Bronze Enhanced Choice B Participation Requirements The Enhanced Choice B package is available statewide and comes with relaxed participation for groups with employees. In regions 15 and 16, EnhancedCare PPO is a plan option. How it works 1 5 eligible employees eligible employees + 66% employee participation minimum + 35% employee participation minimum + Employer pays minimum of 50% of base plan monthly or Employer pays a minimum of $100 per employee toward the employee-only rate = Access to Health Net s Enhanced Choice B portfolio Dental plan Plan pays Member pays Vision plan Member pays Orthodontia DPPO Classic % / $1,500 lifetime max. Annual plan maximum Annual deductible Cleanings Exams X-rays Exam / Frames Lenses (single / bifocal / trifocal / progressive) $1,500 $50 / $150 $03 $0 3 $0 3 Preferred $10 copay / $0 copay, up to $100 allowance DPPO Classic Not covered $1,500 $50 / $150 $03 $0 3 $0 3 Preferred $10 copay / $0 copay, up to $100 allowance DPPO Essential Not covered $1,000 $50 / $150 $03 $0 3 $0 3 Preferred Value 10-2 Not covered / $0 copay, up to $100 allowance DPPO Essential % / $1,500 $1,500 $50 / $150 $03 $0 3 $0 3 lifetime max. DPPO Essential Not covered $1,500 $50 / $150 $03 $0 3 $0 3 DHMO Plus 150 DHMO Plus % over $1, % over $1,695 N/A N/A $0 $0 $0 N/A N/A $0 $0 $0 $25 / $25 / $25 / $90 $25 / $25 / $25 / $90 $10 / $10 / $10 / $75 Infertility benefits are available on all plans at an additional cost. 1 Counties available: PPO: Available in all counties. EnhancedCare PPO: Los Angeles County. Full HMO, WholeCare HMO, PureCare HSP: All or parts of Alameda, Contra Costa, El Dorado, Fresno, Kern, Kings, Los Angeles, Madera, Marin, Merced, Napa, Nevada, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare, Ventura, and Yolo counties. SmartCare HMO: All or parts of Los Angeles, Orange, Riverside, San Diego, San Bernardino, Santa Clara, and Santa Cruz counties. Salud HMO y Más: All or parts of Kern, Los Angeles, Orange, Riverside, San Bernardino, and San Diego counties. CommunityCare: Los Angeles, Orange and San Diego counties. 2Maximum copayment after deductible (if any) of $250 for an individual prescription of up to a 30-day supply on Tier 4 drugs. 3Deductible waived. 4Maximum copayment after deductible (if any) of $500 for an individual prescription of up to a 30-day supply on Tier 4 drugs. 5Not available through Covered California. 6After the medical deductible has been reached, the member is responsible for 100% of the eligible charges until the out-of-pocket maximum limit is met. 7 Visits 1 3: The calendar year deductible is waived (combined between office visits, urgent care, prenatal and postnatal visits, outpatient mental health/substance abuse). Visits 4 unlimited: The calendar year deductible applies. 8 After the pharmacy deductible has been met, you pay 100% of the cost for all Tier 1, Tier 2, Tier 3, and Tier 4 drugs. Maximum after deductible of $500 for an individual prescription of up to a 30-day supply until the out-of-pocket maximum has been met. 16

19 Underwriting Guideline Summary Effective on the first day of your renewal month, choose either Enhanced Choice A or Enhanced Choice B to offer your employees as many plans as you would like, from one plan to all plans within the selected package. Enhanced Choice program Requirements and guidelines: Enhanced Choice A package: 1 5 eligible employees, minimum 66% participation; eligible employees, minimum 50% participation. Enhanced Choice B package: 1 5 eligible employees, minimum 66% participation; eligible employees, minimum 35% participation. Can be written as sole carrier or alongside another carrier. Minimum employer contribution of 50% of the lowest cost plan or $100 per employee toward the employee-only rate. Composite rates are not available. If selected, the chiropractic rider will be applied to all HMO and HSP plans within the package. Note: Chiropractic is no longer embedded within SmartCare medical plans. Employers who wish to pair SmartCare with chiropractic must select the chiropractic rider. Group number assignments Certain plan changes will result in a new group number assignment. Medicare secondary payer data collection Please see the Employer Group Size Verification Form to record any changes to your TIN and to update your worldwide employee counts. This request is the result of a new federal reporting requirement for health plans to provide CMS (Centers for Medicare & Medicaid Services) with certain information that will enable CMS to more effectively pay for the health insurance benefits of Medicare beneficiaries who also have coverage under group health plan arrangements. We appreciate your assistance and timely response to our data request so that we may comply with this mandate. 17

20 Understanding Rates At Health Net, our goal always is to minimize rate adjustments, so you can continue to provide health care benefits to your employees. Rates take into account many variables, such as new technologies and rising health care costs. Small Group premiums have been affected by the following changes related to the Affordable Care Act for ACA-compliant health plans: Age limited to a 1:3 ratio. Example: The rate for a 64-year-old can t be more than three times (300%) the rate for a 21-year-old. Each family member is rated individually based on his/her age. For the purpose of rating, the member s age is determined at the time a policy is issued or renewed. Only the first three children under age 21 are charged. Rates based on the geographic rating region of the employer. Regional rating areas are now grouped together for rating based upon the regions chosen by the state of California. Health status has been removed as a rating factor. Your premium is priced as part of one Health Net rating pool. Your pricing is adjusted to reflect the average risk in the state of California. In addition, your premium reflects the following new taxes and fees: Additionally, there is another $0.34 per participant per month charge to cover two other federal fees. CA Exchange Fee applies only on our PPO business; 5.2% of premium to fund Covered California for Small Business (formerly called the Small Business Health Options Program, or SHOP). In the event additional federal or state legislative guidance or regulatory requirements emerge that result in a modification of the estimated impact of the benefit mandates, taxes or fees, Health Net reserves the right to further adjust its premium schedule. While rate increases are typically necessary for us to continue providing access to quality care, we realize that higher health expenditures have an impact on small businesses, especially in today s challenging economy. You may be able to offset a renewal rate increase or even save over current rates by switching to a different plan or plans. For example, a plan with a deductible or a higher office visit copayment could lower rates. Evaluate your options using our 2018 benefit overviews. See page 14 in this guide. Health Insurer Fee approximately 2.3 percent of premium in

21 Ancillary Programs Questions? Need more information? Please contact Health Net Account Management at , option 2. 19

22 Dental Plans That Make You Smile Does your plan include optional dental and vision coverage for your family? With Health Net, you can choose from a full line of affordable dental and vision coverage products and have a single point of contact for all your health care needs. Rates for these products, for new sales only, follow this section. For renewal rates, more information or to purchase any of these products, please contact your Health Net account manager. Health Net Dental HMO and PPO plans may be purchased separately or as a dual choice when sold in conjunction with Health Net of California, Inc. or Health Net Life Insurance Company medical coverage products. Pediatric dental coverage (ages newborn through 18) is automatically included on all of our plans purchased directly through Health Net. Some of the key advantages of these products are listed here. Dental HMO key plan benefits An extensive network of Dental HMO (DHMO) providers. Many dental procedures are covered at listed copayments. In addition to the procedures already covered in the plan, additional cleanings and adult fluoride are covered. Material upgrades, such as porcelain and semiprecious or precious metal molar crowns, are included as a covered benefit. General anesthesia and cosmetic and elective dentistry are covered. These procedures are typically not covered under most other carriers dental plans. Teeth whitening is covered at the listed copayment. DHMO plans may be purchased separately or as a dual choice with Dental PPO plans. Implant coverage for children and adults (subject to copayments). Footnotes found at the end of this section. 20

23 Dental PPO key plan benefits Health Net makes available a range of affordable, flexible Dental PPO plans (DPPO). From Classic to the feature-packed Essential plans, Health Net DPPO plans will make you smile. These plans include the following features: Large statewide and national network of Dental PPO providers. Periodontics, endodontics and oral surgery are covered in general services. Classic plans reimburse out-of-network benefits at Usual, Customary and Reasonable (UCR) 1 amounts. May be purchased separately or as a dual choice with Dental HMO. All of our DPPO plans offer pregnant women additional cleanings and periodontal maintenance when medically necessary (not subject to the deductible and does not apply to the calendar year maximum). Employees and dependents receive the full amount of the orthodontia lifetime maximum, even if they have begun treatment under another carrier s dental PPO plan (applies only to DPPO Classic with orthodontia coverage). Essential plans reimburse out-of-network benefits on a limited fee schedule. No waiting periods. 21

24 DPPO plan features Classic This plan has a $1,500 calendar year maximum. Classic offers full coverage for preventive services. Classic plan This plan has a $1,500 calendar year maximum. Classic offers full coverage for preventive, general and major services. Classic covers orthodontia with a $1,500 lifetime maximum. Essential This plan has a $1,000 calendar year maximum. Essential reimburses out-of-network benefits on a limited-fee schedule. This plan offers full coverage for preventive, general and major services. Essential This plan has a $1,500 calendar year maximum. Essential covers orthodontia with a $1,500 lifetime maximum. DPPO Classic DPPO Classic In-network Out-of-network 2 In-network Out-of-network 2 Calendar year maximum $1,500 $1,500 Calendar year deductible $50 single / $150 family Preventive services (initial/routine oral exam, teeth cleaning and routine scaling, fluoride treatment, sealant children under 15, space maintainers, X-rays as part of a general exam, emergency exam) General services (fillings, general anesthetics, oral surgery, periodontics, endodontics) Major services (crowns, removable and fixed bridges, complete and partial dentures) Orthodontia 3 (adult and child) $75 single / $225 family $50 single / $150 family 100% deductible waived 100% deductible waived $75 single / $225 family 80% deductible waived 80% after deductible 80% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible / $1,500 lifetime maximum 22 Health Net Dental plans may be purchased on a standalone basis or in conjunction with a Health Net medical plan. This is only a summary of benefits. Please refer to the Certificate of Insurance for terms and conditions of coverage, including which services are limited or excluded from coverage. Footnotes found at the end of this section.

25 Essential Same features as Essential , with a $1,500 calendar year maximum. Underwriting highlights Dual option available Group may select 2 DPPO plans, 2 DHMO plans or 1 DHMO and 1 DPPO plan. (Please see Small Business Group Dental and Vision adult buy-up guidelines on page 35 to determine if the group qualifies for dual option.) Voluntary DPPO plans without orthodontia are available to groups with a minimum of 2 enrolled employees. Voluntary DPPO plans with orthodontia are available to groups of 10 or more enrolled employees. DPPO Essential In-network Out-ofnetwork 4 DPPO Essential DPPO Essential In-network Out-ofnetwork In-network Out-of- 4 network 4 Calendar year maximum $1,000 $1,500 $1,500 Calendar year deductible $50 single / $150 family Preventive services (initial/routine oral exam, teeth cleaning and routine scaling, fluoride treatment, sealant children under 15, space maintainers, X-rays as part of a general exam, emergency exam) General services (fillings, general anesthetics, oral surgery, periodontics, endodontics) Major services (crowns, removable and fixed bridges, complete and partial dentures) Orthodontia 3 (adult and child) $75 single / $225 family $50 single / $150 family $75 single / $225 family $50 single / $150 family $75 single / $225 family 100% deductible waived 100% deductible waived 100% deductible waived 80% after deductible 80% after deductible 80% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible / $1,500 lifetime maximum Not covered Limitations Initial / routine oral exam Teeth cleaning Fluoride treatment Sealants Emergency treatment 2 per consecutive 12 months 2 per consecutive 12 months (additional services available for pregnant members) 2 per consecutive 12 months, children under 16 years only 1 per 36 months, children under 16 years on permanent molars only For relief of pain only Health Net Dental plans may be purchased on a standalone basis or in conjunction with a Health Net medical plan. This is only a summary of benefits. Please refer to the Certificate of Insurance for terms and conditions of coverage, including which services are limited or excluded from coverage. Footnotes found at the end of this section. 23

26 Vision Plans with a Clear Advantage Providers can be found by calling Health Net Vision Member Services toll-free number at Or visit us online at Pediatric vision coverage (ages newborn through 18) is automatically included on all plans. We also offer adult Health Net Vision PPO insurance plans (ages 19 and older), which provide the convenience of a large national network, our hasslefree implementation, administrative processing, and: A diverse network of independent and retail providers, including LensCrafters. Low copayments. Employees and dependents can see any provider they choose, either in-network or out-of-network, and be covered under the plan. Discounts of 5 15% on LASIK and PRK from U.S. Laser Network. 5 The only difference between the full service plans, Preferred and , is the replacement of lenses, contact lenses or frames either every 12 or 24 months, respectively. In addition, Health Net offers the Preferred Value 10-2 plan, which covers materials only. Schedule of benefits and coverage Vision exam copay Lens copay Frequency Exam Eyeglass or contact lenses Frames Retail frame allowance (in-network) Contact lens allowance (in-network) Health Net Vision plan benefits Vision exam (Preferred and Preferred plans only) Exam (with dilation as necessary) Standard contact lens fit and follow-up exam Standard plastic lenses Single vision Bifocal Trifocal Standard progressive (add-on to bifocal) Premium progressive (add-on to bifocal) Lens options (in-network only) UV coating Tint (solid and gradient) Standard scratch-resistant Standard polycarbonate Standard anti-reflective Other add-ons and services Frames (any frame available at a provider location) Contact lenses (materials only) Medically necessary Conventional Disposable Laser vision correction (in-network only) LASIK or PRK from U.S. Laser Network Secondary purchase plan (in-network only) Discounts on eyewear purchases after initial benefits 24 Footnotes found at the end of this section.

27 Preferred Plan Preferred Plan Preferred Value Plan 10-2 $10 $10 Not covered $25 $25 $10 Every 12 months Every 12 months Not covered Every 12 months Every 24 months Every 12 months Every 24 months Every 24 months Every 24 months $100 $100 $100 $90 $90 $90 In-network (member cost) Out-of-network (maximum benefit allowed) $0 after copay Up to $40 Up to $55 Not covered $0 after copay Up to $40 $0 after copay Up to $60 $0 after copay Up to $80 $65 copay (in addition to lens copay) $60 $65 copay (in addition to lens copay), plus 80% of retail charge less $120 allowance $60 $15 copay Not covered $15 copay Not covered $15 copay Not covered $40 copay Not covered $45 copay Not covered 20% discount Not covered Up to plan allowance, plus 20% discount off balance over allowance Up to $45 $0 Up to $210 Up to plan allowance, plus 15% discount off balance over allowance Up to plan allowance, plus balance over allowance 15% off retail price or 5% off promotional price Up to $105 Up to $105 Not covered 40% off retail Not covered Employees and dependents will receive a 20 percent discount on remaining balance beyond plan coverage at participating providers, which may not be combined with any other discounts or promotional offers, and the discount does not apply to provider s professional services or to contact lenses. Retail prices vary by location. Discounts do not apply for benefits provided by other group benefit plans. Allowances are one-time-use benefits; no remaining balance. Lost or broken materials are not covered. This is only a summary of benefits. Please refer to the Certificate of Insurance or Evidence of Coverage for terms and conditions of coverage, including which services are limited or excluded from coverage. 25

28 Chiropractic Care That Won t Put You in a Pinch You may choose to add chiropractic care to your HSP or HMO medical plans. We work with American Specialty Health Plans of California, Inc. 6 (ASH Plans) to offer this additional coverage that more employees are seeking. Acupuncture care is a covered benefit on all medical plans. $10 office visit copayment. $50 annual chiropractic appliance allowance toward the purchase of medically necessary items such as supports, collars, pillows, heel lifts, ice packs, cushions, orthotics, rib belts, and home traction units. Medically necessary laboratory tests. Services or supplies excluded under the chiropractic care program may be covered under the medical benefits portion of the plan. Consult the plan s Evidence of Coverage for more information. Our PPO, EnhancedCare PPO Value and HDHP plans include chiro Chiropractic benefits are included with several of our PPO and EnhancedCare PPO plans. There s no need to buy separate coverage! Platinum 250/15, Gold 1000/30, Silver 2000/55, and Value plans: $25 copayment per visit, 12 visits per year, no deductible HDHP plans: $25 copayment per visit, unlimited visits, deductible applies Plus! You can pair one of these PPOs with any of our HMO or HSP plan designs whether or not you want to buy chiropractic coverage. 26

29 Plan for the Unexpected For many small businesses, an attractive employee benefits package includes Group Term Life and Accidental Death & Dismemberment (AD&D) insurance offering desirable benefit levels. This allows a small business employer to: Increase the attractiveness of the company s benefit package to employees. Offer employees life insurance benefits at economical rates. One way you can enhance your benefits package and minimize administrative costs is to consolidate health and life insurance carriers. Carrier consolidation eliminates unnecessary administrative costs related to managing an employee benefits package. Health Net Life Insurance Company underwrites Group Term Life Benefit Insurance, Accidental Death & Dismemberment and Dependent Life Insurance. Group Term Life Insurance Life options Option A $15,000 flat amount for all employees. Option B $25,000 flat amount for all employees ( employees). Option C $50,000 flat amount for all employees ( employees). Group Life plan features Waiver of premium provision A life benefit can be extended during a period of total disability under terms specified in the group Certificate of Insurance. Accelerated death benefit Provides financial protection to the insured in time of need, while also protecting the interest of the beneficiary. The accelerated benefit is a portion of the basic life insurance amount and is payable in a lump sum. Conversion privilege A conversion privilege to whole life insurance is available to certain individuals whose coverage terminates due to reasons specified in the group policy. Accidental Death & Dismemberment (AD&D) These benefits are usually included as part of the group life insurance policy. Health Net Life Insurance Company does not offer Accidental Death & Dismemberment benefits on a standalone basis. Benefit is payable as a result of an accidental loss of life or any of the physical losses specified in the group policy. The maximum benefit amount is equal to the basic life amount shown in the policy. This maximum benefit amount is payable for loss of life. It can also be payable for the loss of sight in both eyes, loss of both hands or both feet, or any two or more of these physical losses in the same accident. One-half of the maximum benefit amount is payable for loss of one hand, loss of one foot or the loss of sight in one eye. 27

30 Rate Guide Dental rating regions by area These are the rating regions by ZIP codes for the PPO plans. Note: Health Net Dental HMO plans are not available in Alpine, Amador, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Inyo, Lake, Lassen, Mariposa, Mendocino, Modoc, Mono, Nevada, Plumas, San Benito, Sierra, Siskiyou, Tehama, Trinity, Tuolumne, and Yuba counties. PPO rating area by ZIP codes Area 1 contains the ZIP codes starting with and Area 2 contains the ZIP codes starting with Area 3 contains the ZIP codes starting with 931, and Area 4 contains the ZIP codes starting with and Area 5 contains the ZIP codes starting with 934, 939 and Area 6 contains the ZIP codes starting with 942. Area 7 contains the ZIP codes starting with Area 8 contains the ZIP codes starting with Note: Area is determined by the employer s home-office ZIP code. Rates apply to new dental groups with effective dates of October 1, 2018, through December 15,

31 Dental HMO Employer-paid group plan Plus DHMO 150-S (Plan code TW) Plus DHMO 225-S (Plan code TX) Voluntary group plan Plus DHMO 150 (V)-S (Plan code U1) Plus DHMO 225 (V)-S (Plan code U2) Specialty referral Minimum enrolled Minimum participation Employee Employee and spouse/ domestic partner Employee and child(ren) Family Yes 2 50% $17.02 $32.34 $34.02 $48.49 Yes 2 50% $14.57 $27.69 $29.15 $41.53 Yes 2 Less than 50% $17.95 $34.09 $35.87 $51.15 Yes 2 Less than 50% $15.12 $28.73 $30.23 $43.10 Voluntary DHMO rates apply to groups with less than 50% participation, less than 50% contribution or who do not have proof of prior group coverage. Dental PPO Plan benefit details Plan code Plan name Deductible TV U0 Classic with Ortho $50 / $150 $75 / $ % / 80% / 50% TT TY Essential $50 / $150 $75 / $ % / 80% / 50% 14S 14T Essential with Ortho $50 / $150 $75 / $ % / 80% / 50% TU TZ Essential $50 / $150 $75 / $ % / 80% / 50% Coinsurance (preventive / general / major services) Employer Voluntary In-network Out-ofnetwork In-network 14U 14V Classic $50 / $150 $75 / $ % / 80% / 50% Out-ofnetwork 100% / 80% / 50% 80% / 80% / 50% 100% / 80% / 50% 100% / 80% / 50% 100% / 80% / 50% Calendar year maximum Orthodontia lifetime maximum $1,500 Not covered $1,500 $1,500 $1,000 Not covered $1,500 $1,500 $1,500 Not covered Voluntary DPPO rates apply to groups with less than 75% participation, less than 50% contribution or who do not have proof of prior group coverage. DPPO orthodontia is available as follows: For groups of 2 9 enrolled employees with proof of immediately prior indemnity orthodontic coverage. For groups of 10 or more enrolled employees. 29

32 Rate Guide Employer-paid dental PPO DPPO plans Area 1 Area 2 Area 3 Area 4 Plan code 14U Classic Employee $59.45 $57.15 $62.46 $42.30 Employee and spouse/domestic partner $ $ $ $84.60 Employee and child(ren) $ $ $ $85.77 Family $ $ $ $ Plan code TV Classic 5 with Ortho Employee $56.22 $54.23 $58.52 $41.19 Employee and spouse/domestic partner $ $ $ $82.38 Employee and child(ren) $ $ $ $90.27 Family $ $ $ $ Plan code TT Essential Employee $34.73 $34.38 $32.79 $27.80 Employee and spouse/domestic partner $69.45 $68.77 $65.59 $55.60 Employee and child(ren) $70.67 $69.99 $66.80 $56.84 Family $ $ $ $88.52 Plan code 14S Essential with Ortho Employee $42.61 $41.80 $41.29 $33.18 Employee and spouse/domestic partner $85.22 $83.60 $82.57 $66.35 Employee and child(ren) $93.98 $92.36 $91.32 $75.14 Family $ $ $ $ Plan code TU Essential Employee $40.00 $39.18 $38.67 $30.56 Employee and spouse/domestic partner $79.99 $78.37 $77.35 $61.13 Employee and child(ren) $81.20 $79.58 $78.54 $62.36 Family $ $ $ $97.17 The above rates are effective when the employer contributes 50% or more of the premium. Requires a minimum of 75% employee participation. Area is determined by group s home-office ZIP code. Details on dental rating areas found on page

33 Employer-paid dental PPO (continued) DPPO plans Area 5 Area 6 Area 7 Area 8 Plan code 14U Classic Employee $58.37 $57.14 $62.86 $55.20 Employee and spouse/domestic partner $ $ $ $ Employee and child(ren) $ $ $ $ Family $ $ $ $ Plan code TV Classic 5 with Ortho Employee $55.39 $54.53 $58.94 $52.61 Employee and spouse/domestic partner $ $ $ $ Employee and child(ren) $ $ $ $ Family $ $ $ $ Plan code TT Essential Employee $34.39 $35.36 $33.26 $34.26 Employee and spouse/domestic partner $68.77 $70.71 $66.51 $68.53 Employee and child(ren) $69.99 $71.93 $67.72 $69.75 Family $ $ $ $ Plan code 14S Essential with Ortho Employee $42.30 $42.24 $41.94 $40.67 Employee and spouse/domestic partner $84.61 $84.48 $83.88 $81.35 Employee and child(ren) $93.36 $93.24 $92.63 $90.11 Family $ $ $ $ Plan code TU Essential 6 Classic Employee $39.69 $39.63 $39.33 $38.06 Employee and spouse/domestic partner $79.38 $79.25 $78.65 $76.12 Employee and child(ren) $80.58 $80.46 $79.85 $77.33 Family $ $ $ $ The above rates are effective when the employer contributes 50% or more of the premium. Requires a minimum of 75% employee participation. Area is determined by group s home-office ZIP code. Details on dental rating areas found on page

34 Voluntary dental PPO DPPO plans Area 1 Area 2 Area 3 Area 4 Plan code 14V Classic Employee $63.43 $60.97 $66.65 $45.08 Employee and spouse/domestic partner $ $ $ $90.16 Employee and child(ren) $ $ $ $91.32 Family $ $ $ $ Plan code U0 Classic with Ortho Employee $59.97 $57.84 $62.43 $43.89 Employee and spouse/domestic partner $ $ $ $87.78 Employee and child(ren) $ $ $ $96.13 Family $ $ $ $ Plan code TY Essential Employee $36.98 $36.61 $34.91 $29.57 Employee and spouse/domestic partner $73.95 $73.22 $69.81 $59.13 Employee and child(ren) $75.17 $74.44 $71.02 $60.37 Family $ $ $ $94.04 Plan code 14T Essential with Ortho Employee $45.41 $44.54 $43.99 $35.32 Employee and spouse/domestic partner $90.82 $89.08 $87.99 $70.64 Employee and child(ren) $ $98.37 $97.26 $79.95 Family $ $ $ $ Plan code TZ Essential Employee $42.61 $41.75 $41.20 $32.52 Employee and spouse/domestic partner $85.23 $83.49 $82.40 $65.04 Employee and child(ren) $86.43 $84.70 $83.58 $66.27 Family $ $ $ $ Voluntary rates apply to those cases with less than 50% contribution, or less than 75% participation, or who do not have proof of prior group coverage. Area is determined by group s home-office ZIP code. 32

35 Voluntary dental PPO (continued) DPPO plans Area 5 Area 6 Area 7 Area 8 Plan code 14V Classic Employee $62.27 $60.96 $67.08 $58.88 Employee and spouse/domestic partner $ $ $ $ Employee and child(ren) $ $ $ $ Family $ $ $ $ Plan code U0 Classic with Ortho Employee $59.09 $58.17 $62.88 $56.11 Employee and spouse/domestic partner $ $ $ $ Employee and child(ren) $ $ $ $ Family $ $ $ $ Plan code TY Essential Employee $36.61 $37.65 $35.40 $36.48 Employee and spouse/domestic partner $73.22 $75.30 $70.80 $72.96 Employee and child(ren) $74.43 $76.51 $72.01 $74.17 Family $ $ $ $ Plan code 14T Essential with Ortho Employee $45.08 $45.01 $44.69 $43.34 Employee and spouse/domestic partner $90.16 $90.03 $89.39 $86.68 Employee and child(ren) $99.44 $99.31 $98.65 $95.97 Family $ $ $ $ Plan code TZ Essential Employee $42.29 $42.22 $41.90 $40.54 Employee and spouse/domestic partner $84.57 $84.44 $83.79 $81.09 Employee and child(ren) $85.77 $85.64 $84.98 $82.29 Family $ $ $ $ Voluntary rates apply to those cases with less than 50% contribution, or less than 75% participation, or who do not have proof of prior group coverage. Area is determined by group s home-office ZIP code. 33

36 Rate Guide Vision Employer-paid Plan Preferred Value (Plan code FO) Preferred (Plan code G0) Preferred (Plan code GI) Vision Voluntary Plan Preferred (Plan code GO) Preferred (Plan code H0) Chiropractic Paired network Full Network, WholeCare, Salud, and SmartCare HMO Exam copay Exam copay Materials copay Employee Employee and spouse / domestic partner Employee and child(ren) Family $10 $25 $8.53 $16.20 $17.05 $25.58 $10 $25 $8.06 $15.31 $16.12 $24.18 Paired medical plan Platinum $10 $3.00 Platinum $20 $3.00 Platinum $30 $3.00 Gold $30 $3.00 Gold $35 $3.00 Gold $40 $3.00 Silver $40 $3.00 PureCare HSP Health Net Platinum 90 HSP 0/15 Health Net Gold 80 HSP 0/25 Health Net Silver 70 HSP 2000/45 Materials copay Chiro rate per member, per month $3.00 $3.00 $3.00 Health Net Bronze 60 $3.00 HSP 6300/75 CommunityCare HMO Gold $5 $3.00 HMO Silver $20 $3.00 HMO Bronze $45 $3.00 Employee Employee and spouse / domestic partner Basic Life and Accidental Death & Dismemberment Tier Employee and child(ren) Monthly rate per $1,000 coverage $ $ $ $ $ $ $ $ $ $ $ $ and over $29.24 Family N/A $10 $4.73 $8.99 $9.46 $14.19 $10 $25 $6.29 $11.96 $12.59 $18.88 $10 $25 $5.76 $10.93 $11.51 $17.27 Note: Chiro is embedded in Full PPO and EnhancedCare PPO Platinum 250/15, Gold 1000/30, Silver 2000/55, Value, and HDHP plans at no additional charge. Footnotes found at the end of this section. 34

37 Small Business Group Dental and Vision adult buy-up guidelines Group eligibility: eligible employees with over 50% of the total group located in California, subject to out-of-area requirements below. Owner-only groups are not eligible. There must be a minimum of one W-2 employee who is not a spouse of the owner. Out-of-area requirements: A maximum of 49% of the total eligible population may be out of California s service area. A maximum of 49% of the total enrolled population may be out of California s service area. Those employees who are out of the California service area may be written on a PPO plan. Carve-outs are not available. Dental and/or Vision may be written on a standalone basis or in conjunction with Medical. Employee eligibility: Probationary period for new hires can be the first of the month following: date of hire, 1 month, 30 days, or 60 days. Note: The probationary period must match Medical. Eligible employees can be defined as employees working at least 20 or 30 hours per week. Note: The hours per week must match Medical employees are not eligible for coverage. With the exception of owners, all employees must be covered by workers compensation. Dependent eligibility: Although dependents under age 19 have access to pediatric dental benefits through their medical plan, they may also be enrolled in a dental buy-up plan to access enhanced benefits. Note: Cosmetic orthodontia is available through Plus DHMO 150 and 225, and DPPO Classic 5 and Essential 5 only. Enrollment details: Groups enrolling in Health Net s Medical with Dental and/ or Vision products or standalone Dental and/or Vision: Employee eligibility is based on the entire group. Minimum participation for the products must be met. Standard paperwork requirements must be met. Existing Health Net Medical groups adding a Dental and/or Vision product: If Dental and/or Vision enrollment is below Medical, paperwork will be required to verify participation on DPPO and employer-paid rates on DHMO and Vision. Rate information: 12-month rate guarantee for cases sold/renewed in conjunction with Medical. Cases sold off-cycle from Medical will have their first renewal in conjunction with Medical. Submission: All cases requesting coverage on the 1st of the month must be submitted by the 5th of the month for which coverage is to be effective. Mid-month effective dates are not allowed. Vision details: A minimum participation of 75% of the eligible employees is required for employer-paid rates. Note: Unlike Medical, waiving for other coverage will count against participation. A minimum employer contribution of 50% of the employee premium is required for employer-paid rates. Voluntary rates apply to those cases with less than 75% participation and/or 50% contribution. A minimum of 2 active subscribers is required. Dual Choice Vision is not available. DHMO details: A minimum participation of 50% of the eligible employees is required for employer-paid rates. Note: Employees waiving coverage due to group coverage through another employer (i.e., spousal coverage) will not count against participation. A minimum employer contribution of 50% of the employee premium is required for employer-paid rates. Proof of prior group coverage is required for employer-paid rates. Voluntary rates apply to those cases with less than 50% participation, less than 50% contribution or that do not have proof of prior coverage. A minimum of 2 active subscribers is required. Orthodontia is available in all DHMO plans. DPPO details: A minimum participation of 75% of the eligible employees is required for employer-paid rates. Note: Employees waiving coverage due to group coverage through another employer (i.e., spousal coverage) will not count against participation. A minimum employer contribution of 50% of the employee premium is required for employer-paid rates. Proof of prior group coverage is required for employer-paid rates. Voluntary rates apply to those cases with less than 50% contribution, less than 75% participation or that do not have proof of prior group coverage. Plans without orthodontia require a minimum of 2 active subscribers for both employer-paid and voluntary. Orthodontia is available for employer-paid DPPO groups of 10 or more active subscribers or for groups of 2 9 enrollees with proof of immediately prior indemnity orthodontic coverage. Orthodontia is available for voluntary DPPO groups of 10 or more active subscribers. Dual Choice dental: Employer-paid rates: A minimum participation of 75% is required. A minimum of 50% contribution is required. Proof of immediately prior group dental coverage is required. Voluntary rates: A minimum participation of 75% is required. No minimum contribution is required. No prior group dental coverage is required. Groups may select 1 DHMO and 1 DPPO with a minimum of 4 active subscribers and 2 on each plan. Groups may select 2 DHMO or 2 DPPO plans with a minimum of 10 active subscribers, with a minimum of 2 on a given plan. Please see the DPPO details section to determine eligibility for DPPO plans with orthodontia and/or implant coverage. 35

38 Small Business Group Life underwriting guidelines Eligibility: eligible employees with over 50% of the total group located in California, subject to out-of-area requirements below. Owner-only groups are not eligible. There must be a minimum of one W-2 employee who is not a spouse of the owner or partner. Out-of-area requirements: A maximum of 49% of the group s eligible population may be out of California s service area. A maximum of 49% of the group s enrolled population may be out of California s service area. Probationary period for new hires can be the first of the month following date of hire, 1 month, 30 days, or 60 days. Note: The probationary period must match Medical. Flat benefit schedules only. Contribution and participation requirements vary by group size. Note: Unlike Medical, waiving for other coverage will count against participation. Carve-outs are not available. Employees must meet the actively-at-work requirement in order to be eligible. Additionally, they must be working full-time at the employer s regular place of business at least 20 hours per week to be eligible. Note: The number of hours must coincide with Health Net Medical eligibility guidelines. Retirees, COBRA enrollees, part-time employees, seasonal employees, and 1099s are not eligible for coverage. Submission: All cases requesting coverage on the 1st of the month must be submitted by the 5th of the month for which coverage is to be effective. For Medical groups that are effective on the 15th of the month, Life coverage will be effective on the 1st of the month prior to the start of Medical coverage. For example, for Medical groups that are effective on 1/15, Life coverage will be effective on 1/1. Groups of 2 9 eligible employees: Standalone Life is not available. Life benefit of $15,000. Employer contribution and participation must be 100%. No more than 25% of employees may be 60 or older. Groups of eligible employees: Standalone Life is available. Life benefit of $15,000. Minimum of 50% employer contribution. Minimum participation: 75% if contributory. 100% if non-contributory. Groups of eligible employees: Standalone Life is available. Life benefit of $15,000 or $25,000. Minimum of 50% employer contribution. Minimum participation: 75% if contributory. 100% if non-contributory. Medical evidence of insurability: EOIs are necessary: If coverage is applied for later than 31 days after the date of eligibility. Subject to Underwriting approval: Medical conditions reported on the EOI. Coverage requiring EOIs will not become effective until approved in writing by Health Net Life Insurance Company. Some SIC classifications are excluded. Footnotes Groups of eligible employees: Standalone Life is available. Life benefit of $15,000, $25,000 or $50,000. Minimum of 50% employer contribution. Minimum participation: 75% if contributory. 100% if non-contributory. 1 Usual, Customary and Reasonable (UCR) is the maximum allowable amount for a dental care service, determined by FAIR Health, Inc. on the basis of the fee usually charged by the provider and data obtained by FAIR Health, Inc. regarding fees charged by providers of similar training and experience for the same service within the same geographic area. 2 Out-of-network benefits for Classic plans are reimbursed at the Usual, Customary and Reasonable (UCR) amounts as determined by FAIR Health, Inc. 3 For employer-paid DPPO plans, orthodontia is available for groups with 2 9 enrollees with proof of immediately prior indemnity orthodontia coverage or for groups of 10 or more enrollees. For voluntary DPPO plans, orthodontia is available for groups of 10 or more enrolled employees. 4 Out-of-network benefits for Essential plans are based on the allowable amount applicable for the same service that would have been rendered by a network provider. 5 Members receive a 15% discount off the retail price or 5% off the promotional price of LASIK or PRK laser vision correction procedures. LASIK and PRK correction procedures are provided by U.S. Laser Network, owned by LCA-Vision. Members must first call LASER6 for the nearest facility and to receive authorization for the discount. 6 Chiropractic care is offered by Health Net of California, Inc. for HMO plans, administered by American Specialty Health Plans of California, Inc., a subsidiary of American Specialty Health Incorporated (ASH). 7 Preferred Value Vision Plan may not be offered on a voluntary basis. 8 Basic Life and Accidental Death & Dismemberment are sold together. Both rates apply. Health Net Dental HMO plans are provided by Dental Benefit Providers of California, Inc. (DBP). Health Net Dental PPO and indemnity plans are underwritten by Unimerica Life Insurance Company. Obligations of DBP and Unimerica Life Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates. Health Net Vision PPO plans are underwritten by Fidelity Security Life Insurance Company and serviced by EyeMed Vision Care, LLC (together, the Fidelity Entities ). Discounts on vision care services and products are made available by EyeMed. The Fidelity Entities are not affiliated with Health Net of California, Inc. or Health Net Life Insurance Company (together, the Health Net Entities ). Obligations of the Fidelity Entities are not the obligations of or guaranteed by the Health Net Entities. 36

39 More Than an ID Card Questions? Need more information? Please contact Health Net Account Management at , option 2. 37

40 Health Net Member Extras 38 At Health Net, we re about more than just health care coverage. Sure, comprehensive benefits are essential, but so is making it easy for people to get the most from their health plan. Decision Power : Health & Wellness Decision Power is an integrated program created to engage people in their health. With personalized tools and achievable goals, employees can feel confident in their ability to make positive and lasting behavioral changes. Through Decision Power, we deliver a personalized and accessible approach to wellness. Here are just a few of the ways we help employees achieve improved wellness: Get help with a specific health goal. Learn about treatment options. Try an online improvement program. Assess health risks with the Health Risk Questionnaire. Track diet, exercise or cholesterol. Better manage chronic illness. Focus on early access and prevention Here at Health Net, we don t wait until people get sick to help out. Our job, always, is to connect your employees with the care they need We want them to use their benefits! That s why we re starting outreach phone calls, mailings and more to encourage our members to get their annual wellness exam. It costs $0 out-of-pocket, and it s the best way for people to know their health status. It s also the most effective way for Health Net to know how best to meet their health needs. From there, we can connect people to the care and resources to help them be their healthiest. Our resources span the full spectrum of health from timesaving conveniences to in-depth support, such as: Easy access MinuteClinics a benefit with all HMOs to make it easy to get care for common illnesses, minor injuries (like a sprain) and vaccines. MinuteClinics (found in select CVS stores) are also available to PPO members. Nurse advice services around-the-clock. Disease management for people living with ongoing health challenges like diabetes, asthma, COPD, heart disease, and heart failure. Our outreach efforts elevate the core Decision Power priority to help reduce highcost service utilization and support workplace productivity by connecting employees with information, resources and support. Boosting health through prevention and early access to care is another way we re doing just that. Health Net online and on the go Self-service at HealthNet.com guides your employees to the information they need with intuitive navigation and useful links. Bookmark for fast and easy access to benefit information, wellness programs, ID cards, and more! It s also the place to find network doctors, hospitals and other services. ProviderSearch at HealthNet.com delivers results by location, specialty or office hours. Plus, users can print or download search results. On the go with Health Net Mobile Keeping track of the details even critical details like health care information can be daunting with today s jam-packed lives. That s why we created the Health Net Mobile app. All it takes is an iphone, Android or other Web-enabled smartphone, and Health Net members have everything they need to track their health plan details no matter where or how busy they are.

41 Group Administration Questions? Need more information? Please contact Health Net Account Management at , option 2. 39

42 Group Administration This quick reference section provides tips for applications, handling group changes and using our convenient online billing and enrollment tools. Turn to the appendix for samples of the following forms: Renewal Election and Open Enrollment Medical Plan Change Request Form Group Size Attestation Form Application tips We ve included a handy submission checklist at the back of the Small Business Application for Group Service Agreement/Group Policy. Use the checklist to cross-check group applications to speed up application processing. Double-check that these items are complete to speed up processing of your application: Date of hire Date of birth Signatures Employees accepting coverage must sign the acceptance section. Employees declining coverage must sign the declination section. Handling group changes Adding employees or dependents Groups can add employees at the following times: New hire (after meeting the company s probationary period) Applications must be received within 30 days of member effective date. Example: The probationary period is the first of the month following date of hire. An employee hired January 15 would have a February 1 effective date. Open Enrollment During the annual renewal period, groups can enroll employees and dependents who had previously declined coverage. Outside of Open Enrollment, dependents can only be added if there is a qualifying event, which includes, but is not limited to: Birth Marriage Court order Adoption Loss of coverage All applications for adding new employees and dependents due to a qualifying event must be signed by the subscriber and received by Health Net within 60 days of the event. 40