Sacramento Area Electrical Workers
Trust Funds
| You Pay | |
|---|---|
| Initial Eligibility Effective Date | 1st of the 2nd month following reserve dollar bank accumulation of $2,000 |
| Continuing Eligibility | $1,000 in reserves for one month coverage |
| Pre-Existing Conditions New Members and Dependents |
None |
| Resident Requirement | Must reside or work within HealthNet service area and select Participating Medical Group/Primary Care physician within 30 miles of home or work. |
| Dependent Coverage | Up to age 19 or 25, if full-time student |
| Office Visit Copayment | $20/visit |
| Deductible | not applicable |
| Annual Out-of-Pocket Limit | $2,000/single $6,000/family |
| Lifetime Maximum | not applicable |
| Death benefit - $7,500 Active Employee Only | all benefits the same |
| Choice of Doctor/Hospital | Services and supplies must be provided, prescribed, authorized, or directed by a HealthNet Health Plan physician at a Health Plan facility, unless specifically noted. |
| Inpatient Hospital | $500 copayment per day* maximum 4 days per admit *up to $1,750 reimbursed by Trust Fund after first $250 paid by member |
| Outpatient Surgery | $500 per procedure* *$250 reimbursed by by Trust Fund |
| Emergency Care | $100 copayment, waived if admitted as inpatient |
| Ambulance | $100 copayment |
| Maternity | $20 copayment per visit |
| Well Baby Care | $20 copayment per visit |
| Immunizations | no charge $20 copayment if age 19 and older for foreign travel/occupational |
| Mental Health | Provided by HealthNet Managed Health Network (MHN), pre-authorization is required. Inpatient: Up to 30 days maximum per calendar year at no charge. Outpatient: 30 visits per calendar year at $0 copayment. Severe Mental Illness: Covered - see member materials for details. |
| Chemical Dependency/Substance Abuse* | Provided by HealthNet Managed Health Network (MHN), pre-authorization is required. Inpatient: Detoxification and rehabilitation provided at no charge. Outpatient: Rehabilitation provided at $0 copayment per visit. *$25,000 Annual Maximum; $35,000 Lifetime Maximum combined |
| Prescription Drugs | |
| Generic | $15 coapyment |
| Brand | $30 copayment |
This comparison chart is merely an overview of the benefits, which are effective January 1, 2009, and does not anemptto cover all the benefit features, limitations, and exclusions In these programs. For details you should consult the materials prepared by Health Net or contact Health Net Member Services at 1-800-522-0088.