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Latest News



Photo of Health Net's Carol Kim Speaking at the California Primary Care Association's Annual Conference is Available on the Associated Press Photo Network
Tuesday, November 5, 2019 4:04 pm PST

Health Net Assisting Members in California During State of Emergency
Tuesday, October 29, 2019 10:20 am PDT

Health Net Assisting Members in the Counties of Los Angeles and Sonoma During State of Emergency
Friday, October 25, 2019 5:00 pm PDT

Available on the Associated Press Photo Network: Health Net Recognized as Diversity Champion by the National Association of Asian Pacifics in Politics and Public Affairs
Wednesday, October 23, 2019 11:45 am PDT

Health Net Assisting Members in Los Angeles and Riverside Counties During State of Emergency
Saturday, October 12, 2019 3:48 pm PDT

Photo of Abbie Totten, Health Net Medi-Cal Program Officer, at the Restoring Healthcare, Restoring Community Summit is Available on the Associated Press Photo Network
Tuesday, October 1, 2019 2:15 pm PDT

Available on the Associated Press Photo Network: Health Net Recognized as a Live Well San Diego Partner
Wednesday, September 25, 2019 4:40 pm PDT

Health Net Invests $3.55 Million to Strengthen California's Health Care Delivery System & Improve Patient Outcomes
Grants Will Support the Collection of Patient Health and Services Data Critical to Meeting the Health Care Needs of Most Vulnerable Patient Populations
Monday, September 23, 2019 5:15 pm PDT

Health Net Appoints J. Brian Ternan as CEO
Monday, September 16, 2019 3:10 pm PDT

Health Net Assisting Members in Kern and San Bernardino Counties During State of Emergency
Tuesday, July 9, 2019 3:30 pm PDT

Sacramento Residents Gain Increased Access to Healthcare Services through New Community Resource Center
Friday, June 21, 2019 3:15 am PDT

Sacramento Residents Gain Increased Access to Healthcare Services Through New Community Resource Center
Thursday, June 20, 2019 9:35 am PDT

Health Net Assisting Members in 25 California Counties During State of Emergency
The California governor's state of emergency includes Amador, Calaveras, El Dorado, Glen, Humboldt, Lake, Los Angeles, Marin, Mendocino, Modoc, Mono, Monterey, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Barbara, Santa Clara, Shasta, Sonoma, Tehama, Trinity, Ventura, and Yolo Counties
Friday, March 1, 2019 12:20 pm PST

John Muir Middle School and Health Net Celebrate National No One Eats Alone Day
Los Angeles Chargers players visited students to bring awareness to social inclusion
Friday, February 15, 2019 11:30 am PST

Health Net Awards $1.2 Million in Grants in California to Increase Access to Healthcare and Improve Health Outcomes
Thursday, January 31, 2019 10:00 am PST

Media Contacts

Health Net Inc. and
Health Net of California
MediaInquiries@HealthNet.com

Health Net Federal Services
Molly Tuttle
molly.tuttle@healthnet.com

Arizona Complete Health
Monica Coury
monica.h.coury@azcompletehealth.com

Health Net Health Plan of Oregon
Debi Farr
dfar@trilliumchp.com

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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