Jul 24, 2024
The Health Net Silver HMO $55 plan copay for Diagnostic Imaging (including X-rays) services is increasing from $60 to $65 effective October 1, 2024, for coverage contracts that started or will start on/after January 1, 2024.
In May we learned (see Refund Being Sent to Some HMO Silver Plan Members), the Health Net Small Group HMO Silver $55 plan (or comparable plan – see list below) had a $750 single/$1,500 family Prescription Drug Deductible. The Prescription Drug Deductible amount should have been $500 single/$1,000 family. Health Net corrected this in their system's in April.
Following is a complete list of impacted plans by year:
- 2021-2022 Small Group HMO Silver $50 plan
- 2023-2024 Small Group HMO Silver $55 plan
- 2021-2024 CalChoice HMO Silver A plan
- 2023-2024 CalChoice HMO Silver D plan
While enrolled on the impacted plans, some members paid more than the $500/$1,000 deductible amount for pharmacy claims. To correct this, members must be refunded for the amount the member overpaid toward their pharmacy deductible.
Additionally, the Department of Managed Health Care requires that the HMO Silver $55 Plan fall within metal tier parameters. Therefore, the copay for Diagnostic Imaging (including X-rays) services has been increased from $60 to $65 effective October 1, 2024, for coverage contracts that started or will start on/after January 1, 2024 in order to meet metal tier parameters.
Communications
- Member letters and refund checks for overpaid Rx deductible for the 2021-2022 plans were mailed in April. Sample Letter 1 2021 & 2022
- Member letters and refund checks for overpaid Rx deductible for the 2023-2024 plans will be mailed in the next few weeks. Sample Letter 2 2023 & 2024
- Employer 60-day notification of change to copay will be mailed by July 26, 2024
- Contract amendments will be mailed by August 30, 2024.
We are committed to keeping you informed - stay connected with your Amwins Connect team for updates.
