Important Update Regarding Health Net HMO Silver $55 Plan
Important Update: Changes to Health Net Small Group HMO Silver $55 Plan
As previously communicated, the Health Net Small Group HMO Silver $55 plan (or comparable plan – see list below) had a $750 single/$1,500 family Prescription Drug Deductible. The Prescription Drug Deductible amount should have been $500 single/$1,000 family. This was corrected in Health Net's system in April.
Following is a complete list of impacted plans by year:
- 2021-2022 Small Group HMO Silver $50 plan
- 2023-2024 Small Group HMO Silver $55 plan
- 2021-2024 CalChoice HMO Silver A plan
- 2023-2024 CalChoice HMO Silver D plan
While enrolled on the impacted plans, some members paid more than the $500/$1,000 deductible amount for pharmacy claims. To correct this, a refund must be processed for the amount the member overpaid toward their pharmacy deductible.
Letters and refund checks for the 2021-2022 plans were mailed in April. Letters and refunds for the 2023-2024 plans will be mailed in the next few weeks. Sample 2023-2024 letters are attached.
Additionally, the Department of Managed Health Care requires that the HMO Silver $55 Plan fall within metal tier parameters. Therefore, the copay for Diagnostic Imaging (including X-rays) services is increasing from $60 to $65 effective October 1, 2024, for coverage contracts that started or will start on/after January 1, 2024. Employer 60-day notifications will be mailed by July 26, and contract amendments will be mailed by August 30.