The “PureCare” Health Care Services Plan (HSP) Operations Manual offers Health Net providers access to important plan benefits, limitations and administration processes to make sure members enrolled in the HSP receive covered services when needed. The Health Net HSP 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 HSP Operations Manual apply to the HSP, unless specified otherwise in the Provider Participation Agreement (PPA), Schedule of Benefits or member's Evidence of Coverage (EOC).
The three provider types - Physicians, Hospitals and Ancillary - are listed at the top of every page. In certain instances, you may see a fourth provider type listed, Participating Physician Groups (PPGs). When a PPG provider type is listed, you will be notified that content does not apply to HSP. 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.