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.