IBEW-NECA Sound & Communications
Benefits Web site
IBEW-NECA Sound & Communications
Benefits Web site
This page contains information on your HealthNet Plan.
NOTE: As of 5/1/07 you now have a Chiropractic benefit covered under this plan.
| ANNUAL COPAYMENT LIMIT | |
|---|---|
| For each member | $1,500 |
| For two-party | $3,000 |
| For each family (3. or more members) | $4,500 |
| OUTPATIENT CARE | |
| Administration of anesthetics | No charge |
| Allergy injection services (serum not included) | $10 Copayment |
| Allergy serum | Not covered |
| Allergy testing | No charge |
| All other injections | $10 Copayment |
| Annual routine physical examinations | Not covered |
| Chemotherapy (professional services only) | No charge |
| Circumcision of newborn | No charge |
| Complications of pregnancy including medically necessary abortions | No charge |
| Dental services (when medically necessary to properly monitor, control, or treat a severe medical condition when excluded dental services are being performed) | No charge |
| Elective abortions | $150 Copayment |
| Genetic testing of fetus | No charge |
| Immunizations for foreign travel/occupational purposes | 20% Copayment |
| Injections related to infertility services | 50% Copayment |
| Normal delivery, Cesarean section (includes newborn inpatient care provided by a member physician) | No charge |
| Nuclear medicine (professional services only) | No charge |
| Other immunizations (except foreign travel/occupational - see above) | No charge |
| Periodic health evaluations (Includes routine, preventive care, and well-baby care) | $10 Copayment |
| Physician visit to hospital or skilled nursing facility (excluding care for mental disorders) | No charge |
| Physician visit to member's home (at discretion of physician) | $20 Copayment |
| Postnatal office visit | No charge |
| Prenatal office visit | $10 Copayment/No charge1 |
| Rehabilitation therapy (inpatient/outpatient physical, speech, occupational and respiratory therapy; provided as long as significant improvement is expected) | $10 Copayment |
| Renal dialysis (professional services only) | No charge |
| Specialist consultations (Includes OB/GYN self-referral) | $10 Copayment |
| Surgeon/assistant surgeon in hospital or PPG | No charge |
| Vision and hearing examinations | $10 Copayment |
| Visit to a physician, physician assistant or nurse practitioner at a Preferred Provider Group (PPG) | $10 Copayment |
| X-ray and laboratory procedures | No charge |
| HOSPITAL INPATIENT CARE | |
| Unlimited days of hospital care in a semi-private room or ICU with ancillary services (excluding care for mental disorders) | No charge |
| Maternity care (Includes routine nursery charges) | No charge |
| Organ and bone marrow transplants (non-experimental and noninvestigative Professional services only) | No charge |
| Outpatient services | No charge |
| Skilled Nursing Facility (limited to 100 days a calendar year) | No charge |
| FAMILY PLANNING | |
| Contraceptive devices | Not covered |
| Infertility services (including professional services, inpatient and outpatient care, treatment | 50% Copayment |
| by injection and prescription drugs, if applicable) | |
| Reversal of sterilization | Not covered |
| Sterilization of females | $150 Copayment |
| Sterilization of males | $50 Copayment |
| MENTAL HEALTH & CHEMICAL DEPENDENCY SERVICES | |
| Administered by Managed Health Network (MHN). Refer to the MHN telephone number on the back of your HealthNet ID card. | |
| OTHER SERVICES | |
| Air ambulance | No charge |
| Blood, blood plasma, blood factors and blood derivatives | No charge |
| Durable medical equipment | No charge |
| Diabetic supplies (refer to the Introduction section for additional information) | No charge |
| Ground ambulance | No charge |
| Hearing aids | Not covered |
| Home health visit (the copayment starts the,31st calendar day after the first visit) | $10 Copayment |
| Hospice care | No charge |
| Medical social services | No charge |
| Patient education | No charge |
| Prosthesis (replacing body parts) | No charge |
| EMERGENCY CARE | |
| Use of emergency room (facility and professional services)3 | $50 Copayment |
| Use of urgent care center (facility and professional services)3 | $50 Copayment |
1For each pregnancy, the initial prenatal visit requires a $10 copayment. No copayment is required for subsequent prenatal office visits.
2 Non-emergency care (including urgently needed care) received within the PPG service area must be performed or authorized by the member’s PPG in order for services to be covered. When urgently needed care is provided outside the PPG service area, authorization is not mandatory in order for services to be covered. When services are provided that meet the criteria for emergency care, whether within or outside the PPG service area, the services are covered, even if the member never contacted the PPG.
3 The copayment will not be required if the member is admitted as a hospital inpatient directly from the emergency room or urgent care center.