Health Net dental insurance. Health Net Dental Plans fit the needs of today's busy families. The focus is on providing access to quality, affordable dental care through a variety of plan types and coverage levels. Health Net Dental Plans provide access to one of the largest dental networks in California—giving you more choices for dental care near your home or workplace.
No, you do not need a referral to see a specialist. You can seek services from any licensed specialist. However, utilizing a PPO contracted specialist will allow you to take advantage of our reduced rates negotiated with the provider.
Although it is not a requirement to pre-authorize treatment, it is strongly recommended (for treatments over $300.00) so you will know in advance: 1) if the service is a covered benefit; 2) The benefit amount to be paid by the Plan; 3) how much you may have to pay for the treatment.
Coinsurance is the percentage of the fee charged by the dentist that is the member’s responsibility. For example: If a procedure is covered at 80% by the insurance company, the remaining 20% is the member’s responsibility.
An annual maximum is the maximum insurance benefit paid out by the plan for each covered member per calendar year. If a member has met the annual maximum no further benefits will be paid until the next calendar year.
This is the dollar amount of the covered charges (within a plan year) that the member must pay prior to the plan beginning to pay out benefits. Each member of the family has their own deductible (maximum of three deductibles per family) to meet in a benefit year.
Using a PPO contracted dental provider allows you to take advantage of our negotiated contract rate with our providers thus lowering a member's out-of-pocket costs.
The primary distinction is that a PPO plan allows the member to choose either a contracted PPO network provider or any licensed dentist for covered services. You do not need to assign yourself or your covered family members to one particular dentist.
