Ambetter PPO

Provider Type

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

Health Net offers the Ambetter PPO plan to individuals through Covered California marketplace and directly through Health Net. Individuals enrolled in the Ambetter PPO plan will obtain covered services using a select tailored network of participating Ambetter PPO providers.

The Ambetter PPO plan includes individual and family plan (IFP) products in the following counties:

Ambetter PPO Products

Effective date

Product type Counties 
January 1, 2018

IFP

Orange
Placer (partial county)
Los Angeles
Riverside (partial county)
Sacramento
San Bernardino (partial county)
San Diego
Yolo

PCPs and Self-Referrals

Members enrolled in Ambetter PPO are required to select a primary care physician (PCP), even though members may self-refer within the Ambetter PPO service area for services that do not require prior authorization. The PCP is listed on the member's identification (ID) card.

Out-of-Network Providers

Members receiving care from out-of-network providers have a higher out-of-pocket cost than receiving care from in-network providers. In accordance with Covered California requirements, Health Net Ambetter PPO providers must provide advance notice to the member when proposing or considering the use of out-of-network providers for non-emergent services as part of their plan of care for a member. An updated listing of Health Net's Ambetter PPO providers is available through the provider portal.