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Coverage Explanation

Provider Type

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

Emergency care by any licensed provider is covered regardless of where services are performed. Emergency services may be provided inside and outside of the service area. 

Medicare individual plans offer worldwide emergency services with $0 copayment. This benefit has an annual maximum of $50,000.

If a member receives emergency care at an out-of-network hospital and needs inpatient care after the emergency condition is stabilized, he or she must have inpatient care at the out-of-network hospital authorized by Health Net. The cost is the cost sharing the member would pay at a network hospital.

For members who are hospitalized at an out-of-network hospital, Health Net may offer to move the member to an in-network hospital when ongoing inpatient care is indicated, however if the member refuses to be transferred, Health Net can not move the member against their will.

Refer to definition of an emergency for more information.

Last Updated: 10/30/2019