Health Net COVID-19 Testing Benefit Changes Coming in 2025
Carrier Updates
Thursday, November 21 2024
In mid-September Health Net notified members about changes to COVID-19 benefits that began November 12, 2023. The implementation of the COVID-19 benefit changes for high deductible health plans were delayed. The following changes for HDHPs will become effective 01/01/2025.
Non-Grandfathered HDHP PPO plans (Group and Ambetter plans)
The member letter stated that for COVID-19 vaccines, members must meet the plan deductible before coverage begins. To clarify:
COVID-19 vaccines received from an out-of-network provider will be subject to plan benefits. No prior approval is required. Subject to plan deductible.
COVID-19 vaccines received from an in-network provider remain at no cost to the member. No prior approval is required. Deductible waived.
For COVID-19 testing and therapeutics, the letter clarifies the following:
COVID-19 testing and therapeutics received from an out-of-network provider will be subject to plan benefits. No prior approval is required. Subject to plan deductible.
COVID-19 testing and therapeutics received from an in-network provider remain at no cost to you. No prior approval is required. Subject to plan deductible
According to Federal requirements, for plan years ending after December 31, 2024, HDHPs may no longer waive cost-share requirements. This includes the deductible for COVID-19 testing and treatment or for out-of-network COVID-19 vaccines if the enrollee has not yet satisfied the HDHP deductible.
For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.
Non-Grandfathered HDHP PPO plans (Group and Ambetter plans)
The member letter stated that for COVID-19 vaccines, members must meet the plan deductible before coverage begins. To clarify:
COVID-19 vaccines received from an out-of-network provider will be subject to plan benefits. No prior approval is required. Subject to plan deductible.
COVID-19 vaccines received from an in-network provider remain at no cost to the member. No prior approval is required. Deductible waived.
For COVID-19 testing and therapeutics, the letter clarifies the following:
COVID-19 testing and therapeutics received from an out-of-network provider will be subject to plan benefits. No prior approval is required. Subject to plan deductible.
COVID-19 testing and therapeutics received from an in-network provider remain at no cost to you. No prior approval is required. Subject to plan deductible
According to Federal requirements, for plan years ending after December 31, 2024, HDHPs may no longer waive cost-share requirements. This includes the deductible for COVID-19 testing and treatment or for out-of-network COVID-19 vaccines if the enrollee has not yet satisfied the HDHP deductible.
For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.