Health Net Insurance Review & Complaints: Health Insurance

California-born Health Net Insurance is a nationwide health insurance company that provides a wide array of plans including individual and group plans as well as administration of Medicare, Medicaid, and Veterans Affairs programs. As of 2016, Health Net operates as a subsidiary of Centene and serves all 50 states as well as the District of Columbia. Our Health Net insurance review covers the history, health coverage options and current ratings of this company.

About Health Net

Health Net was founded in 1977 as a nonprofit organization, a status that lasted until 1992 when the company transitioned to for-profit operations. Founded in California, Health Net expanded quickly with the 1993 merger with Qualmed that resulted in the formation of Health Systems International; a further merger in 1997 with Foundation Health Systems made the company the 4th largest insurer in the U.S., serving 17 states. In 2000, the company changed its name back to the original Health Net.

In March of 2016, Centene completed its acquisition of Health Net, with the name remaining the same. Health Net programs are now available in every part of the country, operating as several branches.

Health Net’s individual health insurance plans are only offered in three Western states: California, Oregon, and Arizona. In the remainder of the country, they offer mainly government-sponsored products, administrating Veteran’s Affairs programs, Medicaid, and Medicare. They are one of the biggest insurance companies in California and also manage Medi-Cal and other government programs.

Health Net has headquarters in two locations; the California office is located in Woodland Hills, CA, and a second location is in St. Louis, MA.

Health Net Insurance Products

In the three states named above, Health Net offers major medical health insurance plans can be purchased individually or offered as employee group benefits. As mentioned, they are also an administrator for multiple government plans. For the purpose of this review, we focused on the plans available in California.

Individual Health Plans

Plans in California are divided into those offered under the Covered California system as well as directly through Health Net. Covered California plans are only available to those who qualify based on income. The plans are similar, but they have some differences in out of pocket costs.

There are three types of plans available: PPO, EPO, and HMO. They vary based on the zip code of the applicant. Most of the plans feature a number in the name that is the coinsurance amount on the plan; copays and deductibles vary.

EnhancedCare PPO

The EnhancedCare PPO plans are offered at multiple levels that vary by coinsurance amount.

They start with the Minimum Coverage (catastrophic) plan and range up to the Platinum 90 plan that has the least amount of out of pocket expense of any of the plans. All of these plans have access to the EnhancedCare PPO network and also provide coverage for out-of-network care. There is one off-exchange plan in this category.

The Catastrophic plan provides three primary care visits free of charge and exempt from the deductible each year. After that, all care is subject to the deductible, and when that is met all care is covered at 100%. The deductible is $7,350 individual (all deductibles are doubled for family).

The Bronze plan has a slightly lower deductible at $6,300, with an out-of-pocket maximum at $7,000. The first three primary care visits are not subject to the deductible and have a $75 copay; this copay applies again after the deductible is met and until the out of pocket max is met.

The Silver plan has a much lower deductible at $2,500. The deductible does not apply to any office visits nor to many other services that instead have copays and coinsurance amounts. Primary care office visits have a $35 copay, specialists $75.

The Gold plan has no deductible for in-network care and copays are $25 for primary care and $55 for a specialist.

The Platinum plan also has no deductible and lower out of pocket costs, with primary care visits at $15 and specialists at $30.

All of the plans include prescription drug coverage.

Other Plans

The regular PPO plans follow the health care exchange’s metal tier levels, starting at the Minimum Coverage plan and going up to the Platinum 90 plan. These are very similar to the EnhancedCare but cover a different region and have a different network. Again, out of network coverage is available. Coverage is much the same as the EnhancedCare PPO plans, with the same deductibles and copays.

The PureCare One EPO plans again come in levels from catastrophic up to Platinum. As an EPO, there is no out of network coverage. There is one Silver level plan that is an off-exchange plan. Again, these plans have the same deductibles and copays as the EnhancedCare plans described above.

The PureCare HSA plans are only offered at catastrophic and bronze levels, which is pretty common for this type of plan. They utilize a Health Savings Account through which all medical bills can be paid until the deductible is met, after which coverage is at 100%.

Finally, there are three CommunityCare HMO plans, offered at Bronze, Silver, and Gold levels. These are managed care plans that limit access to only the provider network and usually require specialist referrals. These tend to be the most affordable plans due to the managed care system. These plans also follow the same pattern of deductibles and copays as the PPO plans.

Medicare Plans

Health Net Insurance writes Medicare Advantage plans in California, Arizona, Oregon, and Washington. The plans vary by state.

In California, Medicare Advantage plans are available at a variety of levels, all with HMO coverage and with varying out of pocket costs. Medicare Supplement plans are also available at several levels.

For more information on Health Net’s Medicare options, read our Medicare-specific review.

Rates

We ran quotes in our sample area for a single 30-year-old, and we received a variety of rates for several plan options.

The lowest rate was for the Minimum Coverage EnhancedCare PPO $207.49, with the Minimum Coverage HSA plan slight more expensive at $235.06.

The mid-range plan, the Silver EnhancedCare, came in at $358.91 a month, while the most expensive plan – the Platinum – was $596.78.

We also received some HMO plan choices, with a Silver HMO plan coming in at $271.72 and the Platinum at $419.

These rates are generally in line with what we have seen elsewhere, with the PPO plans not surprisingly are more expensive than the HMO, but not by a large amount.

Claims

Like all health care service plans, Health Net handles claims directly with providers. Determination of coverage for claims payment will follow the plan benefits provided by your health insurance policy. There may be rare situations where a customer has to submit for reimbursement, but this is not often.

HMO plans usually have some of the quickest internal billing due to the lack of out of network coverage, but as long as your providers are in network everything should run fairly smoothly in terms of claims submission.

Ratings and Consumer Reviews

There is a variety of Better Business Bureau (BBB) pages for Health Net’s different branches. Health Net of California at the Woodland Hills headquarters has a D rating with the BBB. The file lists failure to respond to eight complaints and six complaints that were not resolved as the reason for the reduced rating. There is a total of 82 complaints on this file in the past three years.

Health Net Plan of Oregon has a B- rating, with the rating lowered for failure to respond to two complaints. The Arizona branch is doing better, with an A+ rating and only 16 complaints in the last three years. There appears to be a pretty big difference in how each branch is performing, even when providing the same level of coverage, but it’s worth noting that the California branch is by far the largest and thus likely to have more complaints.

There are a total of 208 reviews of Health Net on Consumer Affairs, with a one-star rating based on the 42 reviews submitted in the past year. Poor customer service and misleading sales information are common complaints, as well as difficulty finding in-network care.

The Yelp reviews are similarly negative, with an overall one-star rating resulting from 155 reviews. Billing mistakes resulting in cancellation are a common complaint here.

Between the issues at the BBB and the similarity of the complaints against this company, there is reason for concern in terms of how they are handling customer service and billing.

The Bottom Line

Health Net Insurance has a lot of plans, and the availability depends on where you live. Their rates are fairly average, with a lot of options to fit just about any budget. The Health Net website provides visitors with more information on their healthcare coverage options. Their reputation, however, leaves something to be desired – it is hard to ignore a D rating from the BBB – which leaves us to recommend that those seeking individual health insurance look elsewhere. They do appear to have a better reputation in Arizona, so insurance shoppers in that state might want to keep them on the list.