Ambetter PPO
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Health Net offers the EnhancedCare PPO plan to individuals through Covered California™ marketplace and directly through Health Net. Individuals enrolled in the EnhancedCare PPO plan will obtain covered services using a select tailored network of participating EnhancedCare PPO providers.
The EnhancedCare PPO plan includes the small business group (SBG) and individual family plan (IFP) products in the following counties:
Effective date |
Product type | Counties |
|---|---|---|
| December 1, 2017 | SBG | Los Angeles |
| 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 EnhancedCare PPO are required to select a primary care physician (PCP), even though members may self-refer within the EnhancedCare 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 EnhancedCare 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 EnhancedCare PPO providers is available through the provider portal.
Contact the Health Net Health Benefit Navigator for inquiries about EnhancedCare PPO.