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HMO SmartCare

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

In order to meet customer demands for lower-priced health care alternatives, Health Net expanded its portfolio of HMO products to include the Health Net HMO SmartCare plans. These HMO offerings provide all the same benefits as existing Health Net HMO plans, but members access these benefits through a select network of providers.

The HMO SmartCare plans for Small Groups are offered in all or parts of Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Cruz, and Santa Clara counties. HMO SmartCare plans for Large and Custom Groups are offered in all or parts of Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Marin, Napa, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Solano, Tulare, and Yolo counties. HMO SmartCare is comprised of selected participating physician groups (PPGs) in these counties contracting with Health Net for the HMO line of business. PPGs were chosen to participate based on meeting Health Net's criteria of cost efficiency for assigned membership.

PPGs do not need to modify existing administrative procedures to accommodate HMO SmartCare members. Members enrolled in a Health Net HMO SmartCare plan receive and access services in the same manner as other Health Net HMO members. For example, members must obtain most services through their selected HMO SmartCare primary care physician (PCP) or PPG. An acupuncture and chiropractic rider is included as part of the HMO SmartCare plans, with these services provided through American Specialty Health Plans, Inc. (ASH Plans). Further, as for other Health Net HMO members, behavioral health benefits are administered by MHN, Health Net's behavioral health care subsidiary. Additionally, SmartCare plans include a $50 wellness benefit administered by Alere.™ Some SmartCare members also have access to CVS® MinuteClinic as part of their plan design; refer to the member's identification (ID) card for more information on this benefit.

Last Updated: 10/31/2019