Self-Referral Benefits

Members may self-refer to a specialist for the following services (subject to benefit limitations):

• Annual well-woman examination
• Obstetrical care
• Behavioral health care (members contact MHN, Health Net's behavioral health division)
• Substance abuse services (members contact MHN)
• Mammograms
• Routine vision examination (if plan includes a vision rider)
• Annual diabetic retinal examination
• Routine hearing examination (excluding Medicare-covered services)
• Annual influenza and pneumococcal vaccine
• Women's routine and preventive services. Health Net arranges for specialty care outside the network when participating providers are unavailable or inadequate to meet the member's medical needs

These self-referral benefits are available with the following limitations:

• Members must use Medicare Advantage (MA) participating and credentialed physicians or clinicians
• Members must receive services from a Health Net participating provider; further, members assigned to a delegated participating physician group (PPG) must receive services from physicians affiliated with the PPG