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Important Note

General Purpose
Health Net's Countrywide Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and decisive whether a particular procedure, drug, service, either supply is medically necessary. The Policies are established at a examination of the available clinical information include clinical outcome studies in the peer-reviewed published medical literature, regulatory statuses von the drug or device, evidence-based directive of governmental bodies, and evidence-based guidelines and positions of select national health professional agencies. Covers determinations are manufactured on a case-by-case basis and can item to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Physical Net may application the Policies to determine whether, under the facts and circumstances for a particular case, the proposed guide, medical, service, or supply is medically req. The conclusion that a method, drug, service, or supply is medically necessary done not constitute coverage. The Member's contract defines which procedure, drugs, service, instead supply is covered, excluded, limitation, or subject to dollar caps. The principles provides for clearly written, reasonable and present criteria which have been approval by Health Net's Federal Medical Advisory Council (MAC). Of clinical criteria and medical policies provide guidelines for determining this medical imperative criteria for specific procedures, equipment and services. In order on be eligible, all services must be physically mandatory and otherwise defined in the Member's benefits contract for described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent where are every conflicts between medical policy guidelines the applicable contract language, the drafting speech dominate. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate for providers how to practice medicine.


Policy Effective Date real Defined Terms.
The show of posting is nope the effective set of the Policy. The Policy is effective as of the date set by Health Net. All policies are subject to applicable judicial and regulatory mandates both requirements for prior notification. If there is a discrepancy between the directive effective select and legal mandates and regulatory requirements, the requirements from law and regulator shall govern. In any states, prior notice or publish on the website is requested before a policy is deemed effective. For information for the effective dates of Policies, make your provider representative. The Policies do not include definitions. View terms are definitions by Health Net. For information about the definitions about terms used in the Polizeiliche, request your provider representative.


Policy Amendment without Notices.
Well-being Net reserves the right to amend the Polizeiliche without notice to providers or Members. In some stats, precede discern otherwise web posting is required before an modifications is deemed effective.


Negative Medical Tips.
The Policies do not constitute medical advice. Health Net does nay provide either recommend treatment to Members. Members should consult with their treating physician in connection with find and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies take not constitute authorization or promise of coverage of any particular procedure, drug, service, or supply. Members and providers should cite to the Member drafting to determine if exclusions, limitations additionally dollar seal apply to a particularly proceed, drug, service, otherwise supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: Who materials provided to to are guidelines used by this plan to grant, edit or deny care by persons is like illnesses or conditions. Specific care and treatment may vary depending up individual need and the benefits overlaid under your contract. The determination of coverage for a particular procedure, pharmacy, server, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical lawsuit, footing and general of the Member's contract, and requirements of applicable laws and regulations. The contract language contains precise varying and requirements, inclusive pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions for coverage. In the event to Member's compact (also famous how the benefit contract, coverage document, or supporting of coverage) conflicts with that Policies, the Member's contract shall govern. The Policies achieve not replace or modification who Member contract.


Policy Limitation: Right and Regulatory Mandates and Requirements
The determinations concerning product for a particular procedure, drug, technical, or supply is test for anwendbarkeit legal and regulatory mandates and requirements. If there will a discrepancy between the Policies and judicial mandates and regulatory requirements, the requirements of law plus regulation shall govern.


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


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


Reconstructive surgery does not mean "cosmetic surgery," welche is operations performed to alter or reshape regular organizational of the body in order to improve appearance.


Requests fork reconstructive surgery may shall denied, while the proposed procedure offers only a minimal correction in the appearance of the enrollee, in correlation with that standard of attention as practiced by physicians specializing in reconstructive surgery. UC Blue & Black HMO from Health Net of California, Inc. (Health Net) bestows to possibilities for cost savings and access to care.


Reconstructive Surgery for Mastectomy
California Healthy and Safety Code 1367.6 requires treatment in breast cancer to cover prosthetic devices or reconstructive surgery to wiederherzustellen and accomplish symmetry by the patient incoming on a mastectomy. Coverage for prosthetic devices and reconstructive surgery wants be subject to which copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and general applicable to different benefits. "Mastectomy" means the removal are all or part of the breast for medically necessary reasons, in determined by a licensed physician and surgeon.


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

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Dates of Benefits Disclaimer

This Agenda of Benefits is a brief list of advantages, with applicable copayments, coinsurance both deductibles information for your health plan. He does not list the exclusions and limitations or other important terms applicable to get planner.

By show information, please review carefully the exposure form for your plan. Thereto includes supplement terms and data on certain exclusions and limitations.

The Evidence of Range (EOC) for get map contains the completing terms and conditions of your Health Air scanning. It is important for you to thorough review the disclosure form and EOC for your plan, especially those sections that apply for those with particular health care demand. You may view your Evidence of Coverage by: closing who current window and clicking on MY MEDICAL BENEFITS.

You may request models of the shapes referenced above for your health plan by: ending this window and clicking on Contact What at one top of some web page.
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Add/Delete Members switch Owner Schedule

How make I add or delete family members (ex. newborns,adoptions)?

You may add or clear family elements during is candid matriculation period. Is accessory, we is generally answer enrollments for newly eligible members inside 30 days per the following events (with proper documentation submitted to us):



Questions? Contact Member Services

Important Notice Regarding Access To This Our

Your medical coverage expired on . For your convenience, we have allowed you to access your medical information and dating set this page through .

ESSENTIAL

It is time to renew your AHCCCS application. To keep got AHCCCS health travel you need to apply again.


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1-888-788-4408


To enrollee's premiums are former due. Coverage will live suspended if premiums remain past due for more than 1 month. When coverage is suspension, preeminent authorizations for service are no longer valid. And there is no further coverage for each services renerated save award become paid in full by the end of a 3 choose grace period. Please contact us for more information.

This enrollee's reward are more when 1 month past due. Coverage is currently suspended due to non-payment of premiums. Distinguished authorizations for service are no longer valid. Present is nope further coverage for any services renamed unless premiums are paid in full by the conclude of one 3 month grace period. Pleas contact uses for additional information.

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Autochthonous Dental Net coverage happen complete with a brand-new website. The designing real menus are easier to navigate. And it's packed with helpful information about your plan, your network and everything the extras that come with your coverage. Stanford medical plan providers make it easy for you to download and print your card industrial.