The HMO Operations Manual offers Health Net providers access to important plan benefits, limitations and administration processes to make sure members enrolled in the HMO plan receive covered services when needed. The Health Net HMO plan is underwritten by Health Net of California, Inc. and is regulated by the California Department of Managed Health Care (DMHC).
Benefits and policies listed in the HMO Operations Manual apply to all HMO plans, unless specified otherwise in the Provider Participation Agreement (PPA), Schedule of Benefits or member's Evidence of Coverage (EOC). Information on the tier one (HMO) of the Point of Service (POS) line of business is also included in the HMO Operations Manual.
The four providers types - Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary - are listed at the top of every page. Refer to the Provider Type listed at the top of the page to see if the content applies to you.
As a Health Net participating provider, you are required to comply with applicable state laws and regulations and Health Net policies and procedures.
The contents of Health Net's operations manuals are in addition to your PPA and its addendums. When the contents of Health Net's operations manuals conflict with the PPA, the PPA takes precedence.