Extension of Benefits

Provider Type

  • Participating Physician Groups (PPG)
  • Hospitals

When a totally disabled member loses coverage because the group agreement between Health Net and the employer group has terminated, California laws require group health plans (HMOs) and group policy underwriters (PPOs) to extend coverage, but only for services directly related to the disabling condition. Application for the extension of benefits must be submitted by the member and certification of the disabling condition completed within 90 days following the date the group agreement terminated. The request for extension of benefits must include written certification by the member's participating physician group (PPG) that the member is totally disabled.

If benefits are extended because of total disability, the member must provide Health Net with proof of total disability at least once every 90 days during the extension, before the end of the 90-day period.

The extension of benefits ends on the earliest of any of the following dates:

  • On the date the member is no longer totally disabled
  • On the date the member becomes covered by a replacement health policy or plan obtained by the group and this coverage has no limitation for the disabling condition
  • On the date that available benefits are exhausted
  • On the last day of the 12-month period following the date the extension began

Refer to the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI) for additional information, or contact the Health Net Provider Services Center.