Network: HPN Leaving SmartCare and Service Area Changes

Effective December 1, 2014, Heritage Provider Network (HPN) leaving SmartCare & Service Area Changes

As with many of the coming changes, Health Net wants you to have the timely and relevant information you need to support your clients.

What you need to know

Heritage Provider Network (HPN) and its affiliated PPGs will be removed from the SmartCare network (pending regulatory approval). This change affects all SmartCare plans including ACA-compliant and transitional relief (grandmothered) plans.

As a result, Health Net SmartCare is withdrawing from 24 ZIP codes within Riverside County (see chart below). This withdrawal does not affect any of Health Net's other tailored networks, such as ExcelCare, or WholeCare

Timing and member access

HPN will be removed from the SmartCare Network for new and renewing groups, on or after December 1, 2014, for new and renewing groups. Existing members whose group renews prior to 12/1 will be able to access HPN PPGs until their group’s next renewal in 2015. Members whose group renews on or after 12/1 will be required to select another SmartCare PPG or product.

HPN providers exiting from the SmartCare Network

• Over 2,031 PCPs, 4,141 specialists
• 30 HPN affiliated PPGs in 4 SmartCare counties – Los Angeles, Riverside, San Bernardino, Orange counties

These ZIP codes will be removed from the SmartCare service area for groups sold or renewed on or after December 1, 2014.

Affected Riverside ZIP codes:

HPN PPGs in SmartCare Network to be removed:

Employer and member communications

Health Net will send the following communications to affected members and employers regarding these changes as outlined below:

• Product closure letters to members, employers and brokers who will lose their plans: Sent 90 days prior to renewal, beginning September 1, 2014.
  
• PPG change letters (PCP crossover/non-crossover) to members: Sent 60 days prior to renewal, beginning October 1, 2014.
  

SmartCare Brok​er 90​-day Letter

SmartCare E​mployer 9​0-day Letter

SmartCare Memb​er 90-d​ay Letter

SmartCare Member Letter Noncrosso​ver 60-day Letter

SmartCare Mem​ber Letter Crossover 60-day Letter

Transition of care

Impacted SmartCare Network members will receive a Transition of Care (TOC) form with their PPG change letters (PCP crossover/non-crossover). Members who meet the criteria for TOC are encouraged to fill out the TOC form and either mail or fax the letter to Health Net’s Medical Management Department. Standard rules of TOC apply.

Have questions?

If you have questions or need more information about this change to the SmartCare Network, please ​contact a member of your b&p Sales Team - 888.722.3373.