Health Net of Arizona 2500 80 60 PPO Plan Information
Plan Name: 2500 80 60 PPO
Prescription Drugs: Yes
Deductible: $2,500 single/ $5,000 family
Coinsurance: 80%/60%
Out-of-Pocket Limit: $3,000 single/ $6,000 family
Lifetime Maximum: $5,000,000
Emergency Room: 20% (subject to $150 copayment per emergency room visit, waived if admitted)
Periodic Health Exam: $30 copayment per physician / $45 copayment per specialist visit
Lab/X-ray: No charge / 20% (subject to deductible) for hospital lab
Maternity - Prenatal/Postnatal: No
Outpatient Surgery: 20% (subject to deductible)
Physical Therapy: Inpatient: 20% (subject to deductible)/ Outpatient: $20 per visit
Skilled Nursing: 20% (subject to deductible)
Home Health Care: 20% (subject to deductible)
Mental Health Office Visits: 20% (subject to deductible)
Chiropractic: 45 per visit
Inpatient Hospital: 20% (subject to deductible)
Mental Health: 20% (subject to deductible)
Maternity: No
Chemical Dependency: 20% (subject to deductible)
Other Health Net of Arizona health insurance plans:
