health net farm bureau health insurance options ca 2011

8/7/2019 Health Net Farm Bureau Health Insurance Options CA 2011

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CALIFORNIA FARM BUREAU MEMBERS HEALTH INSURANCE PLANS

A GUIDE TO ALLYOUR HEALTHINSURANCE OPTIONS

Medical Dental Vision Supplemental term lie insurance Supplemental medical expense coverage

Eective January 1, 2011Exclusively or Farm Bureau members
http://www.healthnetworkinsurance.com/


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Get a quote online here

http://www.healthnetworkinsurance.com/ca-get-quote
http://www.healthnetworkinsurance.com/ca-get-quote


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11no-cost extras

DECISION POwER: HEALTH IN bALANCE 11

SEL-SERvICE AT www.HEALTHNET.COm 12

ARm bUREAU mEmbERSHIP DISCOUNT PROGRAmS 12

13getting started

STEP 1: CHECk ELIGIbILITY 13

STEP 2: CHOOSE A HEALTH PLAN 13

STEP 3: SEND YOUR APPLICATION 13

COmmON qUESTIONS 14

15major medical expense coverage

outline of coverage

READ YOUR CERTIICATE CAREULLY 15

mAjOR mEDICAL ExPENSE COvERAGE 15

PRINCIPAL bENEITS AND COvERAGES 15

ExCLUSIONS AND LImITATIONS 16

PRE-ExISTING CONDITIONS OR AGES 19 AND OLDER 18

RENEwAbILITY O THIS CERTIICATE 18

PREmIUmS 18

LOSS RATIO 19

SUPPLEmENTAL TERm LIE INSURANCE ExCLUSIONS 19

TERmINATION O SUPPLEmENTAL TERm LIE INSURANCE 19

HEALTH NET vISION AND DENTAL ExCLUSIONS & LImITATIONS

CONTENTS

2011 HEALTH NET

HEALTH INSURANCE PLANS AND OTHER HEALTH PRODUCTSOR THE CALIORNIA ARm bUREAU mEmbERS HEALTH INSURANCE PROGRAm

2california farm bureau federation

and health net

PROTECTING CALIORNIA AGRICULTURE

PROTECTING YOUR HEALTH 2

HELPUL DEINITIONS 3

4choosing the plan that fits your life

Cb SENSIbLE HSA NG 4

Cb bUDGET PPO NG 5

bENEITS AT-A-GLANCE 5

SUmmARY O bENEITS 67

8dental and vision

DENTAL 8

DENTAL SUmmARY O bENEITS AND RATES 8

vISION 9

vISION SUmmARY O bENEITS AND RATES 9

10rounding out your coverage

THE CASHNET PLAN 10

SUPPLEmENTAL TERm LIE INSURANCE 10

www.healthnetworkinsurance.com


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2

Caliornia FarmBureau Federationand Health NetProtecting Caliornia agriculture,protecting your healthFor more than 75 years, the Caliornia Farm Bureau

Federation (CFBF) has protected and promoted

agricultural interests throughout Caliornia. Today,

anyone can join the Farm Bureau and benet rom

local county Farm Bureau representation and exclusive

membership oers like aordable health insurance.

When you join the Farm Bureau, youre eligible or an

exclusive line o Health Net insurance plans. Here at

Health Net weve designed a line o economical plans

to give you what you need most right now rate relie.

Whats more, our Caliornia Farm Bureau plans come

with extra resources and services to help you make the

most o your health. Its a combination that has made

us the choice o so many Caliornians. Among the

reasons that make Health Net a better decision:

1. We know Caliornia.Headquartered in Caliornia, Health Net has

been giving Caliornians access to broad networks,

personal service and useul wellness resources or

over 28 years, so they can manage their health the

way they want.

2. We have broad networks or more choice.Approximately 61,000 doctors, over 300 hospitals

and over 4,300 retail chain and independent

pharmacies give you the choices you deserve.And with such large provider networks, theres

a good chance your doctor is part o ours. Plus,

our worldwide emergency coverage protects you

wherever you travel.

Economical solutions one more

way Health Net is hard at work

to make protecting your health.

www.HealthNetworkInsurance.com

3. We save you time.Online tools. People to talk with on the phone.

With a Health Net plan, its easy to get answers

and to get things done.

4. Were ocused on quality.

Ongoing service monitoring helps ensure the careyou receive is the right care or you. Plus, you

can assess network quality or yoursel with the

provider and hospital comparison reports that we

make available online at www.healthnet.com.

5. We ll be here when you need us.Health Net Lie Insurance Company is backed

by Health Net, Inc., one o the nations largest

publicly traded managed health care companies,

with more than 6.6 million customers in the U.S.

Financially sound, the companys health plan and

insurance subsidiaries provide health and mental

health benets to millions o individuals. In times

like these, its good to know that your health plan

is aliated with a strong, national company.

Plus, Farm Bureau members get great discounts on

brand-name products and valuable resources to help

you make the most o your health. See No-Cost

Extras, starting on page 11, or details.

http://www.healthnetworkinsurance.com/ca-get-quotehttp://www.healthnetworkinsurance.com/ca-get-quotehttp://www.healthnetworkinsurance.com/


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HELPFUL dEFINITIONS

In this guide, youll see ords used that are specic to health care. wee dened the here to ae eerything

ast to read and easy to understand.

2) threatens the patients lie, or, i let untreated, ill

cause urther serious ipairent to the patients

odily unction.

Out-of-pocket maximum The aount o coered

charges that you ust pay in addition to applicale

copays and deductiles.

when you see the ter out-o-pocet aiu,

it eans the dollar liit o your share o health

care epenses.

PPO The Preerred Proider Organization

designated y us and/or any other health care

proider contracting organization that has

contracted ith Health Net.

Up-front coverage Up-ront coerage eans

that you can use certain serices eore you

eet your deductile. You ust pay a set

copay at the doctors oce. Also called rst

dollar coerage.

Applicant-onl plan Coers one person on a

Certicate o Insurance. multiple aily eers

can apply using the sae enrollent or. Single

rates apply to each aily eer. SeparateCerticates o Insurance ill e issued once the

application is approed.

Coinsurance The percentage o costs you pay

or coered serices, usually ater you eet your

deductile. These aounts ary y health plan.

Copa The dollar aount that a coered person is

reuired to pay or certain enets in addition to any

applicale coinsurance and/or deductile payents.

deuctible The aount o coered charges or hich

a coered person or aily unit has to incur and pay

each calendar year eore enets are payale. Certain

serices are aailale eore the deductile is et.

Emergenc An illness or accidental inury that:

1) reuires iediate care or edical interention;

3www.healthnetworkinsurance.com


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Youhavecompletecontroloveryourhealthcare

dollars and can use them when you like.

Whenusedforqualiedmedicalorpharmacy

expenses, contributions (up to the IRS maximum)

and withdrawals are tax-ree.

Long-termsavings,rolloverfeatures(notimelimit

or using the unds) and catch-up contributions

or members between the ages o 55 to 65.

Bonus Option! Health Net has partnered with Bank

o America to oer our members an HSA thats easy

to administer, quick to set up, and that comes with

a convenient Bank o America VISA debit card or

account access.

CFB Sensible HSANG the plan that makes sensein a challenging economy.

Reerences are to ederal taxes only. State taxes may apply. Taxinormation is or general purposes only. For more detailedinormation about the tax implications o an HSA, please contacta proessional tax adviser. A complete list o qualifed medicalexpenses can be ound in IRS publication 502 Medical andDental Expenses, at www.irs.gov.

The HSA component o EZ Access HSA is oered by Bank oAmerica, N.A., as trustee o the HSA. Health Net is not afliatedwith Bank o America, N.A.

Choosing the planthat ts your lieHealth Net oers Farm Bureau members a selection

o PPO health insurance plans so you can nd thehealth plan that ts your budget and your lie. These

plans are underwritten by Health Net Lie Insurance

Company.

PPOplansgiveyoufreedomofchoice.Youcango

to a doctor or hospital in our PPO network or the

highest benet coverage there are approximately

61,000 providers and over 300 hospitals statewide to

choose rom or you can see a provider not in our

network and pay a greater share o the costs.

Child and children-only coverage is available or all o

our plans.

CFB SenSiBle HSAnG

Our Health Savings Account (HSA)-eligible PPO

insurance plan makes it possible to take advantage o

tax-savings opportunities while you protect your health.

$5,200calendar-yeardeductible.Forfamily

coverage, the calendar year deductible is two-times

the individual amount.

100%ofin-networkcoverageforcoveredbenets

ater your calendar year deductible is met.

100%ofin-networkcoverageforadultandchild

preventive care (deductible waived).

Ater you enroll, you can open an HSA. When you

have an HSA, you can use tax-ree dollars to pay or

plan deductibles, copays and other qualied medical

expenses. The HSA belongs to you; you keep it even iyou change jobs or retire. Other key acts about HSAs:

Youcancontributeupto$3,050toyourHSA

asanindividualor$6,150ifyouhavefamily

coverage. These are the 2011 maximum

allowable amounts as set by the IRS.



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5

BeneFitS At-A-GlAnCe

This chart is a summary o in-network benets only and not intended or enrollment purposes. For benet

details, please see the Summary o Benets.

1Deductile aied or rst 2 isits.

CFB BudGet PPO nG

The CFB Budget PPO NG insurance plans pair

reedom and fexibility with lower monthly premiums.

Twocalendaryeardeductiblechoicesgiveyou

fexibility in nding the premium/deductible

combination that ts your budget best.

Individualdeductibles:$6,000or$7,500

Applicant-onlycoverage

Youcanseethedoctor(upto2visits)fora$50copay

(deductible waived).

100%in-networkcoverageforadultandchild

preventive care (deductible waived).

Three-tierandspecialtyprescriptiondrugcoverage.

Forallotherservices,thisplanpays100%of

in-network coverage or covered benets ater your

calendar year deductible is met.

CFB Budget PPO NGs the solution or essential

health coverage at a reasonable cost.

LIFETIME MAXIMUM: Unliited CFB SENSIBLE HSA NG CFB BUdGET PPO NGApplicant-Only Plan

CALENdAR yEAR dEdUCTIBLES $5,200 single(aily deductile is 2 the indiidual)

$6,000 or $7,500

CALENdAR yEAR OUT-OF-POCKETMAXIMUM

$5,200(includes deductile) (2 or aily)

$0

VISIT TO PHySICIAN No charge ater deductile is et $50 copay per isit1

X-RAy ANd LABORATORy No charge a ter deductile is et No charge a ter deductile is et

MATERNITy CARE Not coered Not coered

PREVENTIVE CARE SERVICES

(ault an chil)

No charge (deductile aied) No charge (deductile aied)

EMERGENCy HEALTH COVERAGE No charge a ter deductile is et No charge a ter deductile is et

OUTPATIENT SERVICES No charge a ter deductile is et No charge a ter deductile is et

OUTPATIENT FACILITy SERVICES No charge a ter deductile is et No charge a ter deductile is et

HOSPITALIZATION SERVICES No charge a ter deductile is et No charge a ter deductile is et

OUTPATIENT PRESCRIPTION dRUGS No charge a ter deductile is et $500 calendar year deductile per person(does not apply to Leel I)

Level I (generic) $10 copayLevel II (orulary rand) $50 copayLevel III (non-orulary rand) 50% or$50 copay (hicheer is greater)Specialt drugs (sel-inectales) 50% or$500 copay (hicheer is less)



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Summary o benetsReer to your Certicate o Insurance or coplete details, eclusions and liitations. In ca se oconfict, the Certi cate o Insurance controls. benets suect to deductile unless noted.

1 Eedded deductile eans one person on a plan it h 2+ eers can eet the indiidual deduc tile and egin receiing coered enets.2 Certain serices ay reuire prior certication ro Health Net. without prior certication, enet is reduced y 50%. Reer to the Certicate o Insurance or details.3 Coered serices ased on the United States Preentie Serice s Tas orce (USPST) grade A and b recoendations; recoendations o the Adisory Coit te

on Iunization Practices (ACIP) t hat hae een adopted y the Director o the Centers or Disease Control and Preention (CDC); and coprehensie guidelinessupported y the Health Resources and Serices Adinistration (HRSA) or inants, children and adolescents.

4 Inpatient is $300 aiu alloale per day. Outpatient aiu payale is $3 0 per isit only applies to Cb Sensile HSA NG.5 The Recoended Drug List is a lis t o prescription drugs that are coered y this plan. Soe drugs reuire prior authorization ro Health Net.

or a copy o the Recoended Drug List, go to .healthnet.co. Reer to a Certicate o Insurance or coplete inoration on prescription drugs.

6

LIFETIME MAXIMUM:Unliited

CFB SENSIBLE HSA NG

IN-NETWORK YOU PAY OUT-OF-NETWORK YOU PAY

CALENdAR yEAR dEdUCTIBLESNot included in calendar year out-o-pocet aiu, ecept on Cb Sensile HSA NG.aily deductile is 2 the single deductile.

$5,200 single(All enets, including outpatient prescription drugs, are suect to the deducti

ecept preentie care. or contracts o to or ore eers, there is an eeddindiidual deductile1.)

CALENdAR yEAR OUT-OF-POCKET MAXIMUMDoes not include calendar year deductile, ecept on in-netor Cb Sensile HSA NG.Payents or serices not coered y this plan ill not apply to this calendar yearout-o-pocet aiu. Copays do not apply to calendar year out-o-pocetaiu, ecept on Cb Sensile HSA NG.

$5,200 single(aily is 2 single)

$5,000 single(aily is 2 single)

PROFESSIONAL SERVICESvisit to physician (including specialist consultations)

No charge ater deductile is et

50%

x-ray and laoratory procedures2 No charge ater deductile is et 50%

Surgeon or assistant surgeon and anesthetic serice No charge ater deductile is et 50%

PREVENTIVE CARE SERVICES (ault an chil)Routine preentie serices and iunizations3

No charge (deductile aied) Not coered

EMERGENCy HEALTH COVERAGEEergency roo (proessional and acility charges)


Urgent care center (acility charges) No charge ater deductile is et

Aulance No charge ater deductile is et

OUTPATIENT SERVICES2

Outpatient surgery (hospital or outpatient surgery center charges only).Out-o-netor aiu alloale charge is $600 per day.


50%

Outpatient acility serices2 No charge ater deductile is et 50%

HOSPITALIZATION SERVICES2

Inpatient, sei-priate hospital roo or intensie care unit ith ancillary serices(unliited, ecept or non-seere ental health and sustance ause treatent).Out-o-netor aiu alloale charge is $600 per day.


50%

MATERNITy CARE Not coered

OTHER SERVICESRehailitatie therapy (includes physical, speech, occupational, respiratory andcardiac therapy) Outpatient: 20-isit aiu per calendar year coined in- orout-o-netor.

No charge ater deductile is et 50%

Chiropractic care / Acupuncture(12-isit aiu per calendar year coined in- or out-o-netor)


mental health or non-seere conditions2,4 No charge ater deductile is et(inpatient and outpatient)

Inpatient: 50%Outpatient: Not coered

Diaetic euipent No charge ater deductile is et Not coered

Durale edical euipent ($2,0 00 aiu payale per calendar year) No charge a ter deduc tile is et Not coered

OUTPATIENT PRESCRIPTION dRUGS5

Prescription drugs lled through participating pharacy (up to a 30-day supply).

Prescription drugs lled through participating ail order (up to a 90-day supply).

medical deductile aied on the Cb budget PPO NG plan.Does not count toards

your calendar year out-o-pocet aiu, ecept on Cb Sensile HSA NG.

No charge ater deductile is et Not coered



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7

CFB BUdGET PPO NGApplicant-Only Plan

IN-NETWORK YOU PAY OUT-OF-NETWORK YOU PAY

$6,000 or $7,500

$0 $6,000

$50 copay per isit (deductile aied orrst 2 isits)

50%



No charge (deductile aied) Not coered





50%



50%

Not coered

Inpatient: No charge ater deductile is etOutpatient: Not coered


Not coered

Inpatient: No charge ater deductile is etOutpatient: Not coered


No charge a ter deduc tile is et Not coered

No charge a ter deduc tile is et Not coered

$500 calendar year deductile per person(does not apply to Leel I)

Level I (generic) $10 copayLevel II (orulary rand) $50 copayLevel III (non-orulary rand) 50% or

$50 copay (hicheer is greater)Specialt drugs (sel-inectales) 50%or $500 copay (hicheer is less)

Not coered

Good health means something

dierent to everyone. How youprotect yours is an individual

choice. Come to Health Net or

health insurance coverage that

fts your health, your lie and

your budget. Apply online atwww.HealthjNetworkInsurance.com

http://www.healthnetworkinsurance.com/ca-get-quotehttp://www.healthnetworkinsurance.com/ca-get-quotehttp://www.healthnetworkinsurance.com/ca-get-quotehttp://www.healthnetworkinsurance.com/


10/24

Dental and VisionWhen you choose a Health Net PPO insurance plan, you have

the option to add on dental and/or vision coverage.

dentAl

Health Net helps you keep your teeth healthy with two dental

plan choices:

TheHealthNetDentalScheduledReimbursementPlan

provides reimbursement at a set rate or dental services

provided by the dentist o your choice.

TheHealthNetDentalHMOplancoversdentalservicesthat

you receive rom a primary HMO dentist in our network.

Youcanchooseaparticipatingofcefromalistofnetwork

providers in your area. To nd a dental HMO provider:

8

The chart on the let is a suary o the enets. or oreinoration, please reer to the Schedule o benets, Eclusionsand Liitations or Health Nets Dental Plans hich can edonloaded ro Health Nets esite at .healthnet.co.

1You ust select a dental HmO netor proider or serices.Procedures perored y a non-netor dentist are not

coered and enrollees are reuired to pay all charges.2maor restorations hae a 12-onth aiting period orthe Scheduled Reiurseent Plan. benets are suectto change.

3benets coer 24 onths o Usual and Custoary (U&C) and24 onths o retention.

USUAL AND CUSTOmARY (U&C) eans charges or dentalserices or supplies essential to the care o the Insured i they arethe aount norally charged y the proider or siilar sericesand supplies and do not eceed the aount ordinarily chargedy ost proiders o coparale serices and supplies in thelocality here the serices or supplies are receied.

HMO1 (You pay) SCHEdULEdREIMBURSEMENTPLAN2 (Plan pays up to)

MAXIMUM CALENdAR Unliited $1,000yEAR BENEFIT

CALENdAR yEAR dEdUCTIBLE $0 $50 per person

dIAGNOSTICOral eaination (up to 2 per year) $0 $24

Intraoral radiographs $0 (Including $62 (Includingiteings eery 3 yrs) iteings eery 5 yrs)

PREVENTIVEProphylais (2 cleanings;once eery 6 onths)

Adult $0 $40

Child (through age 18) $0 $28

Sealant (per peranent olar tooth) $5 (through age 15) $26 (through age 17)

RESTORATIVEAalga (peranent llings)

One surace $0 $38

To suraces $0 $48

Cron2 (porcelain/ceraic) $245 $220

PROSTHETICS/PROSTHOdONTICS2

Denture (coplete upper or loer) $325 each $315

ENdOdONTICSRoot canal (ecluding nal restorations)Anterior $110 $193

molar $265 $306

ORAL SURGERy (extractions)Single tooth $5 $39

Reoal o ipacted tooth $80 $134(copletely ony)

ORTHOdONTICSChildren (through age 19) 75% o U&C3 Not coered

Adult 75% o U&C3 Not coered

monthly rates eectie 7/1/08. Rates suect to change.

HMO SCHEdULEdREIMBURSEMENTPLAN

MEMBER $20.00 $39.00

MEMBER +1 $38.00 $78.01

MEMBER +2 OR MORE $58.00 $111.16

Go to www.healthnet.com.

Select Find a Doctor or Hospital.

Select Find providers by city, county, state or ZIP,

then select I Agree.

Select State.

Select the box or Dental (Dentists, DentalHygenists, etc.) then Search.

Select Commercial Health Plans Optum.

This will redirect you to a new page showing a

disclaimer. Please read and clickContinue. This will

take you to Health Net Dental plans.

Select Locate Dentistlink rom the let

navigation bar.

Select DHMO CA ONLY.

Select the appropriate search criteria, then key

in the Search Fields and select Submit.

Choose your dentist and include the Practice

ID# in the specied area on the application.

Please note: The Health Net Dental HMO plan is

not available in all counties. Please see the Monthly

Premium Rate Guide or details.

dentAl SummAry OF BeneFitS And rAteS



11/24

Aitional Purchases anOut-of-Pocket discounts

meer ill receie a 20% discount on itesnot coered y the plan at ParticipatingProiders. The discount does not apply tocontracted proiders proessional serices ordisposale contact lenses. benets ay note coined ith any discount, prootionaloering, or other group enet plans.Alloances are one-tie use enets; noreaining alance. Lost or roen aterialsare not coered.

The Health Net vision Secondary Purchaseplan proides up to a 40% discount o

coplete pair o eyeglass purchases and a15% discount o conentional contact lensesonce the initial enet has een used.

ViSiOn SummAry OF BeneFitS And rAteS

monthly rates eectie 1/1/06. Rates suect to change.

PPO VISION PLAN

MEMBER $13.66

MEMBER +1 $26.65

MEMBER +2 OR MORE $38.25

MEMBER COST OUT-OF-NETWORK

REIMBURSEMENT

EXAM WITH dILATION AS NECESSARy $10 copay $45

CONTACT LENS FIT ANd FOLLOW-UP(Contact lens t and to ollo-up isits areaailale once a coprehensie eye-ea haseen copleted.)

Standard $0 copay / it and to $40ollo-up isits paid in ull

Preiu $0 copay / 10% o retail price, $40then apply $55 alloance

FRAMESAny aailale rae at proider location $0 copay / $85 alloance $45

or any rae plus 20%o alance oer $85

STANdARd PLASTIC LENSESSingle ision $0 copay $43

biocal $0 copay $58

Triocal $0 copay $70

Lenticular $0 copay $125

LENS OPTIONSUv coating 20% discount Not coered

Tint (solid and gradient) 20% discount Not coered

Standard scratch-resistance 20% discount Not coered

Standard polycaronate 20% discount Not coered

Standard progressie (add-on to iocal) 20% discount Not coered

Standard anti-refectie 20% discount Not coered

Other add-ons and serices 20% discount Not coered

CONTACT LENSES(includes aterials only)

Conentional $0 copay / 15% discount $105o alance oer $120

Disposales $0 copay / balance oer $120 $105

medically neces sary $0 copay $210LASER VISION CORRECTIONLASIk or PRk ro U.S. Laser Netor 15% o retail price, or Not coered

5% o prootional price

FREQUENCyEaination Once eery 12 onths

rae Once eery 24 onths

Lenses or contact lenses Once eery 24 onths

9

ViSiOn

Our fexible and aordable PPO vision program will keep

you seeing clearly.

Youchoosewheretogoatthetimeofservicenoneed

to select a vision provider when you enroll. Note that

you pay less when you see an in-network vision provider.

Highstandardsofqualityandservice.

Completevisualexaminationevery12months

($10copaymentapplies).

Framesoneframeevery24months(maximum

allowance$85in-network,upto$45out-of-

network).

For more details, please reer to Health Nets PPO

Vision Plan schedule.



12/24

10

Age $10,000 $20,000 $30,000 $40,000 $50,000

117 $1.00 N/A N/A N/A N/A

1829 $1.90 $3.80 $5.70 $7.60 $9.50

3039 $2.40 $4.80 $7.20 $9.60 $12.00

4049 $5.00 $10.00 $15.00 $20.00 $25.00

5059 $13.70 $27.40 $41.10 $54.80 $68.50

6064 $20.00 $40.00 $60.00 $80.00 $100.00

Individual Term Lie Insurance Coverage Amounts

monthly rates eec tie 7/1/08. Rates suect to change.

Rounding outyour coverageRound out your health coverage with optional

products that deliver added nancial protection.

tHe CASHnet PlAn

CashNet is a supplemental medical expense plan that

helps bridge the cost o hospitalization, surgery or an

accident. For a modest monthly premium, you get

cash reimbursements which are paid directly to

you when you need them or:

Hospital stays

$300perdayforhospitalcoveredchargesforall

illnesses and accidental injuries.

Maximumof30dayspercalendaryear.Lifetime

maximum o 300 days.

Accidental injury:Uptoamaximumof$500peryear. Not applicable to Child(ren)-only policies.

Ambulancetransportation due to an accident:

$300forlandtransportation.

$1,000forairtransportation.

Not applicable to Child(ren)-only policies.

Mammography:Upto$100withamaximumo 1 visit per calendar year.

YoucansupplementanyHealthNethealthplan

with CashNet even our HSA-compatible CFB

Sensible HSANG plan.

Other important things to know:

TheCashNetPlanisasupplementtohealth

insurance, underwritten by Health Net Lie

Insurance Company. It is not a substitute or

hospital or medical expense insurance, a health

maintenance organization (HMO) contract or

major medical expense insurance.

PaymentofCashNetbenetsissubjecttoallother

terms o the policy. Please reer to the Certicate

o Insurance or a list o exclusions and limitations.

SuPPlementAl term liFe inSurAnCe

YoumayapplyforSupplementalTermLife

Insurance when you apply or your medical plan. Iyou are approved or health coverage, your term lie

coverage is also approved.

Health Net oers Supplemental Term Lie

Insurance, underwritten by Health Net Lie

Insurance Company, or adults (up to age 64) in

coverageamountsof$10,000,$20,000,$30,000,

$40,000and$50,000.Themaximumcoverage

amountforchildrenages117is$10,000.

Simply complete the Supplemental Term Lieportion o the application. Premium is billed

separately rom your health insurance.



13/24

11

No-cost extrasdeCiSiOn POwer: HeAltH in BAlAnCe

Inormation, resources and support or every person,every stage o health

With Health Net, you get more than health care coverage.

YougetDecisionPower1. Decision Power brings together

under one roo the inormation, resources and personal

support that t you, your health and your lie.

Whether you

haveaquestion

wanthelpwithaspecichealthgoal

needtreatmentbutwanttounderstandallyouroptions

arelivingwithillness you choose how and when to use the inormation,

resourcesandsupportavailable.YoucanuseDecision

Power online. Or by calling a Health Coach. Try multiple

resources at once, or one at a time. 24 hours a day, seven

days-a-week, Decision Power is here or you.

Log on to www.healthnet.com:

Take the health risk questionnaire (HRQ) With its

instant results and interactive eatures, the HRQ is your

gateway to recommendations and resources based on yourunique health prole. Among the highlights: youll receive

email alerts on inormation and action steps to take based

on your HRQ results.

Try a step-by-step plan or losing weight, stopping

smokingorboostingnutrition.Youcanstartwithour

online coaching and sel-help tools. Phone coaching support

is included, so making lasting, healthy changes is easier.

Track your health progress and build a complete medical

snapshot to have whenever you need it with a Personal

Health Record.

Find supportor any kind o mental health concern such

as depression, alcohol use, eating disorders, etc.

Be informed Access inormation resources, such

as Healthwise Knowledgebase, an online health

encyclopedia; HEAR Audio Library, which contains

inormation on 355 health topics; and Health

Crossroads Web Modules, which explains the pros

and cons o various treatments.

Know your numbers with our health trackers

(cholesterol, diet, tness), treatment cost estimator and

hospital comparison reports.

Talk to a Health Coach to get:1-to-1 consultations and a single point o contact or

anyandeveryhealthquestion,goalorsituation.Youcan

talk to the same Health Coach every time you call.

Steps to avoid Cardio-Metabolic Syndrome the

combination o three or more o the six risk actors

(e.g., waist size, blood pressure, HDL cholesterol level)

that predict diabetes, heart disease and colon, uterine

and prostate cancers.

24-hour answers to health questions or concerns.Always call 9-1-1 or go straight to the emergency room

in a lie-threatening situation.

Techniques to help you eel comortable talking with

your doctor and expressing your preerences.

Pointers or setting achievable health goals; guidance

on evaluating treatment options.

Guidance and supportor living with an ongoing

illness such as asthma, diabetes, heart disease, etc.

Specialized consultation rom nurse case managers to

help both patients and amily members deal with the

complexity o end-stage illnesses.

YoucanuseDecisionPowerwheneveryouwantand

as much as you like. Because when it comes to your

health, theres more than one right answer.

24-hour answers to health

questions or concerns.

1 Decision Power is not part o Health Nets commercial medica l benet plans.

Also, it is not aliated with Health Nets provider network and it may berevised or withdrawn without notice.



14/24

12

SelF-SerViCe At www.HeAltHnet.COm

At www.healthnet.com we make it ast and easy to

get things done on your schedule. Once youre a

Health Net member, it will take only a minute to

register online. With your user name and password,

you can:

OrderIDcards.

Seeyourplandetails.

Viewpharmacybenets.

SearchforaphysicianorspecialistinCalifornia.

Comparemedicalgroupandhospitalqualityand

service ratings.

Findapharmacistnearyou.

Getforms.

EmailtheCustomerContactCenter.

Useourinteractivetools.

Learnabouthealthconditions.

Andmuchmore!

FArm BureAu memBerSHiP

diSCOunt PrOGrAmS

In addition to all the Health Net no-cost extras,

Farm Bureau members have access to many exclusive

products and discount programs. Enjoy smart, new

ways to save hundreds o dollars a year.

20%eyeweardiscountLensCrafters

FarmBureauPrescriptionDiscountProgram

Upto30%discountonpaintandsupplies

Kelly-Moore and Dunn Edwards Paint

10%offGraingercommercialandhomeimprovement products ree shipping or online

orders

RentalcardiscountsAvis,HertzandBudget

Traveldiscounts

DodgeandRAMtrucksrebate

Themeparkdiscounts

7.5%discountonautoinsuranceAlliedand

Nationwide Insurance

FarmBureauBankfullrangeofnancialservices

10%discountonLandsEndproductsandlogofees

Upto25%offStarkeyHearingAidsandhearing

products, plus signicant savings on other hearing

health care needs through ClearValue Hearing

Healthcare Benets Plan



15/24

13

Getting startedSteP 1: CHeCk eliGiBility

There are our requirements to meet:

Forsixcontinuousmonthsorlonger,beaCaliornia resident under age 65 who is not

eligible or Medicare.

Meetourmedicalunderwritingguidelines.All

applicants are subject to medical underwriting to

determine medical risk. Based on the results o the

medical underwriting, one or more o the ollowing

may happen:

Coverage may be oered at the standard rate.

Coverage may be oered at a higher rate.

Coverage may be oered or a dierent plan

or deductible.

Coverage may not be oered.

BeorbecomeaCaliforniacountyFarm

Bureau member.

Betheapplicantsspouse,ortheapplicants

Caliornia-registered domestic partner, under

age 65, who is not eligible or Medicare.All dependent children under age 26 may apply or

dependent coverage, subject to medical underwriting

guidelines.

SPeCiAl OPen enrOllment FOr

CHildren under 19 yeArS OF AGe

There is an Open Enrollment period or children

under age 19. Please talk to your broker or contact

Health Net or more inormation.

SteP 2: CHOOSe A HeAltH PlAn

Reviewthebenetchartshownonpages67to

determine which plan best ts your needs.

For a premium quote, please call 800-569-1156.

Completeanapplication.Theapplicationmust

be completed and signed by the applicant. Be sure

to ll out the health application accurately and

completely. An incomplete application will delay

the process.

Yourapplicationrequiresthatyouremainamember o the Farm Bureau. I you are not

a member, please ll out the Farm Bureau

application.

Youhavethefollowingoptionsforpayingyour

annual Farm Bureau membership dues:

Submit your annual membership dues along

with your health premium and application.

Youwillreceiveannualbillingsdirectlyfrom

the Farm Bureau or membership renewal.

YoucanpayyourFarmBureaumembership

dues monthly. It will be included with your

selectedmonthlypaymentmethod.A$2.00

monthly administrative ee will be included.

Youalsogettochoosethepaymentmethod

you preer or your monthly premiums. The

choices are:

Automatic bank drat (ABD): automatically

withdraws the premium rom your checking orsavings account (you choose which account).

Credit card: monthly, repetitive charge to your

VISA or MasterCard.

Monthly billing by mail.

SteP 3: Send yOur APPliCAtiOn

Send your completed and signed application, along

with the appropriate premium, to your Health Net

authorized agent or mail to the address listed on theapplication.Yourinitialpaymentcanbechargedto

your VISA or MasterCard as noted on the health

application.

Preer to apply online? Ask your Health Net

authorized agent about details or an online

application.



16/24

14

COMMON QUESTIONS

What PPO octors an facilities can I use?

You hae access to the Health Net Lie netor,

one o Caliornias largest, ith approiately

61,000 PPO physicians and oer 300 hospitals.

To nd a proider:

1. Go to

2. Choose Find a Doctor or Hospitalro the

hoe page.

3. Search y Proider, near your address or y city,

county, state or ZIP.

4. Select plan PPO & PPO Plus to pull up the

netor that applies to ar bureau.

Can I appl for health coverage for mchilren onl?

Yes. All o our health insurance plans are aailale

or child/children-only coerage. Special children

rates are aailale.

Is it possible for m spouse to have aifferent plan from mine?

Sure. many couples nd that their indiidual healthcare needs ary and ant dierent coerage

aounts and deductiles. I you apply or dierent

plans/deductiles on one application, applicant-

only rates ill apply. Your authorized agent can tell

you ore.

Is preventive care covere?

Yes. Adult and child preentie care is a coered

enet. Please reer to the enet chart or

coerage inoration.

Is there a separate euctiblefor prescriptions?

I your plan includes the 3-tier prescription drug

enet, there is a separate $500 calendar year

deductile or Leel II, Leel III and Specialty

Drug tiers.

I you hae the Cb Sensile HSA NG plan, there

is no separate prescription deductile, hoeer,your edical plan deductile ust e et

eore any prescription enets are payale.

Wh o I nee a California

Farm Bureau membership?

These Health Net plans are only aailale

to ar bureau eers. The ar bureau

meers Group Health Progra has sered its

eers since 1947. Your annual eership in

a county ar bureau supports the agriculturalindustry in Caliornia. Plus you get eer

discounts on any aluale products and

serices including hotel, car rentals and ore.


http://www.healthnetworkinsurance.com/http://www.healthnetworkinsurance.com/http://www.healthnetworkinsurance.com/


17/24

15

Health Net Lie Insurance CompanyCaliornia Farm Bureau MembersHealth Insurance PlansMajor Medical Expense CoverageOutline o Coverage

reAd yOur CertiFiCAte CAreFully

This outline o coverage provides a brie description

o the important eatures o your Certicate o

Insurance (Certicate). This is not the insurance

contract and only the actual Certicate provisionswill control. The Certicate itsel sets orth, in detail,

the rights and obligations o both you and Health Net

Lie Insurance Company. It is, thereore, important

that you read your Certicate careully!

mAjOr mediCAl exPenSe COVerAGe

This category o coverage is designed to provide, to

persons insured, benets or major hospital, medical

and surgical expenses incurred as a result o a covered

accident or sickness. Benets may be providedor daily hospital room and board, miscellaneous

hospital services, surgical services, anesthesia services,

in-hospital medical services, out o hospital care

and prosthetic appliances subject to any deductibles,

copayment provisions, or other limitations which may

be set orth in the Certicate. Basic hospital or basic

medical insurance coverage is not provided.

PrinCiPAl BeneFitS And COVerAGeS

Please reer to the pages 67 o this booklet or a

summary o each plans covered services and supplies.

Also reer to the Certicate you receive ater you

enroll in a plan. The Certicate oers more detailed

inormation on the benets and coverage included in

your health insurance plan.

Reproductive health services

Some hospitals and other providers

do not provide one or more o the

ollowing services that may becovered under your Certicate o

Insurance and that you or your

amily member might need: amily

planning; contraceptive services,

including emergency contraception;

sterilization, including tubal ligation

at the time o labor and delivery;

inertility treatments; or abortion.

Youshouldobtainmoreinformation

beore you enroll. Call your prospectivedoctor, medical group, independent

practice association or clinic, or call

Health Net Lies Customer Contact

Center at 1-800-839-2172 to ensure

that you can obtain the health care

services that you need.



18/24

16

exCluSiOnS And limitAtiOnS

The ollowing is a partial list o services that are

not generally covered. For complete details on any

plans exclusions and limitations, please see the

Health Net Lie Caliornia Farm Bureau Members

Health Plan Certicate.

Servicesorsuppliesthatarenotmedicallynecessary.

Anyamountsinexcessofthemaximumamounts

specied in the Certicate.

Pregnancyormaternityservicesexceptasspecied

in the Certicate.

CosmeticsurgeryexceptasspeciedintheCerticate.

Contraceptivedrugsand/orcertaincontraceptive

devices are covered as specied in the Certicate.Vaginal contraceptive devices are only covered when

a Physician prescribes the device and perorms a

tting examination as specied in the Certicate.

DentalservicesexceptasspeciedintheCerticate.

TreatmentandservicesforTemporomandibular

(Jaw) Joint Disorders.

Surgeryandrelatedservicesforthepurposesof

correcting the malposition or improper development

o the bones o the upper or lower jaw, except whensuch procedures are Medically Necessary.

Foodordietary,nutritionalsupplements,except

or ormulas and special ood products to prevent

complications o Phenylketonuria (PKU).

Visioncareincludingcertaineyesurgeriestoreplace

glasses, except as specied in the Certicate.

Optometricservicesoreyeexercises,exceptas

specically stated elsewhere in the Certicate.

Eyeglassesorcontactlensesandeyeglasses,exceptas

specied in the Certicate.

Sexchanges.

Servicestoreversevoluntarysurgicallyinduced

inertility.

Servicesorsuppliesthatareintendedto

impregnate a woman are not covered.

Certaingenetictesting.

Experimentalorinvestigativeservices.

Routinephysicalexams,exceptforpreventive

care services (e.g., physical exam or insurance,

licensing, employment, school or camp). Any

physical, vision or hearing exams which are

not related to diagnosis or treatment o illness

or injury, except as specically stated in the

Certicate.

Immunizationsorinoculationsforadultsor

children, except as described in the Medical

Benets section or or oreign travel or

occupational purposes.

Servicesnotrelatedtoacoveredillnessorinjury.

Custodialordomiciliarycare.

Inpatientroomandboardchargesincurredin

connection or an admission to a Hospital or

other Inpatient treatment acility primarily or

diagnostic tests which could have been perormedsaely on an outpatient basis.

Inpatientroomandboardchargesinconnection

with a Hospital stay primarily or environmental

change, physical therapy or treatment o

chronic pain.

Anyservicesorsuppliesfurnishedbyanon-

eligible institution, which is other than a legally

operated Hospital or Medicare-approved Skilled

Nursing Facility, or which is primarily a place

or the aged, a nursing home or any similar

institution, regardless o how designated.

ExpensesinexcessofaHospitals(orother

Inpatient acilitys) most common semi-private

room rate.



19/24

17

Infertilityservices.

Allergyserum.

Privatedutynursing.

Mentalandnervousdisorderandsubstanceabuse

treatment, except as specied in the Certicate.

Hyperkineticsyndromes,learningdisabilities,

behavioral problems or mental retardation.

However, certain o the above conditions shall be

covered as outlined in the Certicate. Over-the-countermedicalsuppliesandmedications.

Personalcomfortitems.

Orthotics,unlesscustommadetottheCovered

Persons body and as specied in the Certicate.

.Educationalservicesornutritionalcounseling,

except as specied in the Certicate.

Hearingaids.

Obesityrelatedservices.

AnyservicesreceivedbyMedicarebenetswithout

payment o additional premium.

Servicesreceivedbeforeyoureffectivedate

o coverage.

Servicesreceivedaftercoverageends.

Servicesforwhichnochargeismadetothe

Covered Person in the absence o insurance

coverage, except services received at a charitable

research Hospital which is not operated by a

governmental agency.

Physicianself-treatment.

Servicesprovidedbyimmediatefamilymembers.

ConditionscausedbytheCoveredPersonscommission (or attempted commission) o a elony

unless the condition was an injury resulting rom

an act o domestic violence or an injury resulting

rom a medical condition.

Conditionscausedbyreleaseofnuclearenergy,

when government unds are available.

Anyservicesprovidedby,orforwhichpayment

is made by, a local, state or ederal government

agency. This limitation does not apply to Medi-

Cal, Medicaid or Medicare.

Servicesforconditionsofpregnancyforasurrogate

parent are covered, but when compensation is

obtained or the surrogacy, we shall have a lien on

such compensation to recover its medical expense.



20/24

18

Anyoutpatientdrugs,medicationsorother

substances dispensed or administered in any

outpatient setting except as stated in the Certicate.

Sexualdysfunctiondrugs.

Rehabilitativeservicesrenderedinanoutpatient

acility are not covered except as specied in

the Certicate.

Rehabilitationtherapyservicesarenotcoveredwhen

provided in connection with the treatment o the

ollowing conditions:

Psychosocial speech delay (includes delayed

language development)

Mental retardation or dyslexia

Attention decit disorders and associatedbehavior problems

Developmental articulation and language

disorders

However, some o the above conditions shall be

covered as shown in the Schedule o Benets

section, i Medically Necessary as described in the

denitions o Serious Emotional Disturbances

o a Child and/or Severe Mental Illness, and

continuous unctional improvement in response to thetreatment plan is demonstrated by objective evidence.

Outpatientspeechtherapy,exceptasspeciedinthe

Certicate.

Servicesandsuppliesobtainedwhileinaforeign

country with the exception o Emergency Care.

Homebirth.

Some services require pre-certication rom

Health Net prior to receiving services. Please reer

to your Certicate or details on what services and

procedures require pre-certication.

Health Net Lie does not require pre-certication

or dialysis services or maternity care. However,

please call the Customer Contact Center at 1-800-

839-2172 upon initiation o dialysis services or at

the time o the rst prenatal visit.

Pre-exiStinG COnditiOnS FOr AGeS 19

And Older

Covered services will not include any care required

in connection with the treatment o any condition,

disease or injury or which medical advice, diagnosis,

care or treatment, including the use o prescription

medications, was recommended by or received rom

a licensed health care practitioner during the six

months immediately preceding the eective date o

coverage under the Certicate. Credit will be given

toward the pre-existing condition waiting period or

membership with another creditable health care plan

i you apply or coverage under Health Net Lies

Caliornia Farm Bureau Members Health Insurance

Program plans within 62 days o termination with

the previous plan.

renewABility OF tHiS CertiFiCAte

Subject to the termination provisions described in

the Certicate, coverage will remain in eect or

each month premium ees are received and accepted

by Health Net Lie. Coverage will terminate i the

group Policy issued to the Caliornia Farm Bureau

Federation by Health Net Lie is cancelled.

PremiumS

We may adjust or change your premium. I we

change your premium amount, notice will be mailed

to you at least 60 days prior to the premium change

eective date. Premiums are automatically adjusted

or changes in your and your dependent spouses or

registered domestic partners ages. Premiums may be

adjusted when your residence address changes.



21/24

19

lOSS rAtiO

Health Net Lies 2009 ratio o incurred claims to

earned premiums or the Caliornia Farm Bureau

Federation Plans is 78.2 percent.

SuPPlementAl term liFe

inSurAnCe exCluSiOnS

No benets will be provided on the death o any

Covered Person under the ollowing circumstances: Deathbysuicidewithintwoyearsfromthe

eective date o Coverage. Our liability shall be

limited to an amount equal to the premiums paid.

Deathbyanyactofwar,declaredorundeclared.

terminAtiOn OF SuPPlementAl term

liFe inSurAnCe

Coverage under this Certicate or a Covered Person

will end on the earliest o the ollowing dates: ThedatetheGroupPolicyends;

Thelastdayoftheperiodforwhichpremiumhas

been paid (subject to the grace period provision);

Thelastdayofthecalendarmonthinwhich:

(a) the Covered Person dies; (b) the Member

ceases to be a member o one o the County Farm

Bureaus comprising the Caliornia Farm Bureau

Federation; (c) the Covered Person becomes

insured under any other Caliornia Farm Bureau

Federation service to member health insurance

program as a member; (d) written notice,

signed by the Member, is received, requesting

termination o coverage or any or all Covered

persons; (e) a Covered person enters active

military service; or () the Covered persons health

coverage under a certicate issued by Us through

the Plan Sponsor terminates;

WithrespecttoaSpouse,thelastdayofthe

calendar month in which the marriage o the

Member and Dependent Spouse is dissolved;



22/24

WithrespecttoaDependentchild,whenthe

child turns 26;

Therstdayofthecalendarmonthinwhicha

Covered Person attains age 65, unless the Covered

Persons birth date is the rst o the month, then

coverage will end on the rst day o the monthprior to the Covered Persons birth date; or

Therstdayofthecalendarmonthinwhicha

Covered Person becomes eligible or Medicare.

When Coverage or the Member ends because the

member becomes eligible or Medicare, Coverage or

a Spouse and any Dependent child(ren) or the lie

insurance benets will end on the date the member

becomes eligible or Medicare.

HEALTH NET VISION AND DENTAL

ExcLuSIONS & LIMITATIONS

Please reer to a Health Net Vision and Dental

Schedule o Benets or inormation.



23/24


24/24

Protect your health while you protect your budget.Health Net makes it easy.For more information, please contact:

Health NetPost Oce Box 1150Rancho Cordova, Caliornia 95741-1150

Individual & Family Plans:

1-800-909-3447

Telecommunications Devicefor the Hearing and Speech Impaired:

1-800-995-0852

www.healthnetworkjinsurance.com

6022928 CA73969 (1/11)Decision Power is not part o Health Nets commercial medical benet plans. Also, it is not aliated with Health Nets provider network and it may be revised or

withdrawn without notice. Decision Power services, including Health Coaches, are additional resources that Health Net makes available to enrollees oHealth Net o Caliornia and Health Net Lie Insurance Company.

Caliornia Farm Bureau Members Health Insurance Plans are underwritten by Health Net Lie Insurance Company. Health Net Dental HMO plans are providedby Dental Benet Providers o Caliornia, Inc. (DBP). Health Net Dental PPO and indemnity plans are underwritten by Unimerica Lie Insurance Company.Obligations o DBP and Unimerica Lie Insurance Company are not the obligations o or guaranteed by Health Net, Inc. or its aliates. Health NetVision is underwritten by Fidelity Security Lie Insurance Company and administered by EyeMed Vision Care, LLC. Fidelity Security Lie Insurance Companypolicy number VC-75 orm number C-9069CA Health Net Lie Insurance Company is a subsidiary o Health Net Inc Health Net and Decision Power are
http://www.healthnetworkinsurance.com/http://www.healthnetworkinsurance.com/http://www.healthnetworkinsurance.com/

health net farm bureau health insurance options ca 2011

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