Health Net: Transparency in Coverage - Cost Comparison Tool

The Transparency in Coverage rule requires Commercial and Marketplace plans to offer a self-service online tool so that members can get cost estimates, and better understand their potential cost-sharing for covered items and services.

What are the Benefits? 

• Price transparency may help members to make more informed healthcare decisions.
• If consumers have greater access to information on the prices for care, they may be better able to shop for more cost-effective providers, helping to lower healthcare spending.

Health Net has partnered with Sapphire Digital to offer this cost comparison tool, using Sapphire’s S365 product. S365 provides the ability to search by billing code or billing code short description for negotiated rates.

S365 versions 23.4 and above are compliant with the Transparency in Coverage mandate for 1/1/24 that requires that members be able to search for billing rates for all covered services and items.

What you need to know

• Members can access Sapphire S365 self-service internet-based tool from their HN.com member portal).
• If the member requests cost estimates in other formats, they can contact the Customer Contact Center (CCC) and ask for the estimate by email or by phone. The CCC will e-mail paper format estimates to the member.
• The tool does not store the cost estimates. However, members may save a PDF copy if they are using the self-service tool.
• The tool provides estimates only. The final costs may differ. 
• Members may use the “Download” option to save information about the costs, or doctors, on the S365 tool as PDF. Members may also share the cost estimates via email.
• For general troubleshooting help with the cost comparison tool members should contact the CCC.
• Health Net will not be issuing any type of communications to the members.

IMPORTANT: Please note that pharmacy cost estimates are not included in the Sapphire S365 self-service internet-based tool. 

To allow members and visitors to look up a drug in a particular formulary, Health Net has added links to the public member and provider pages to allow visitors to look up a drug. This won’t provide pricing on a specific drug. However, it will confirm whether a particular drug is in on the visitor’s formulary of interest. 

To obtain information regarding pricing of a specific drug, members will need to call the CCC or look it up via CVS’s lookup tool. 

To utilize the CVS lookup tool, member’s need to be logged into their HealthNet.com member portal account. Reference the attached screenshots for details on how to look up a drug on a Health Net formulary and how to utilize the CVS lookup tool.

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Questions?

If you have any questions, please contact your Health Net Representative.