Self-Referral Benefits
Provider Type
- Physicians
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