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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 
Last Updated: 10/31/2019