Health Net: Update to CA Commercial COVID-19 Benefit Change Member Notices

For Commercial Group and Individual & Family Plans

In mid-September Health Net notified members about changes to COVID-19 benefits that begin November 12, 2023. 

Health Net will be mailing correction notices to impacted members regarding the following changes: 

Ambetter PPO plans 

The member letter stated that COVID-19 vaccines received from an out-of-network provider would not be covered. This is incorrect. COVID-19 vaccines received from an out-of-network provider will be covered and will be subject to plan benefits.

Non-Grandfathered HDHP PPO plans (Group and Ambetter plans)

The member letter stated that for COVID-19 vaccines, members must meet the plan deductible before coverage begins. To clarify: 

• COVID-19 vaccines received from an out-of-network provider will be subject to plan benefits. No prior approval required. Subject to plan deductible. 
• COVID-19 vaccines received from an in-network provider remain at no cost to the member. No prior approval required. Deductible waived.

For COVID-19 testing and therapeutics, the letter clarifies the following:

• COVID-19 testing and therapeutics received from an out-of-network provider will be subject to plan benefits. No prior approval required. Subject to plan deductible.
• COVID-19 testing and therapeutics received from an in-network provider remain at no cost to you. No prior approval required. Subject to plan deductible.

Please see the letters that will be mailed from 11/8/23 through 11/10/23 to impacted members, in the links below:  

• Non-Grandfathered Ambetter PPO member correction letter
• Non-Grandfathered HDHP PPO member correction letter

If you have any questions, please contact your Health Net Account Executive or broker services.