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Product has lower price than traditional HMO

Posted On: Jun. 17, 2007 12:00 AM CST

The Health Net Optimizer HMO is a fully insured product available to employers with 51 or more employees.

Under the plan, employers deposit $500, $750 or $1,000 into health reimbursement arrangements earmarked for each participating employee. Plan members use special debit card to access the funds, which can be used to make copayments and pay any other out-of-pocket costs such as coinsurance for hospitalization or a deductible applied to brand-name drugs.

Health Net uses either experience rating or, in the case of smaller employers, adjusted community rating, to price the product. It is priced at about 18% to 20% lower than the company's traditional HMO products.

Plan members receive the additional incentive of having up to $200 deposited in their HRAs by HealthNet: $100 for completing a health risk questionnaire; and another $100 for contacting "Decision Power," the HMO's health coach, within six months of a hospitalization.

HealthNet offers six different plan designs with copayments ranging between $10 and $50 for office visits, X-ray and lab services. Out-of-pocket maximums range between $3,000 and $4,000 annually per plan member.

Members must choose a gatekeeper primary care physician at enrollment as with a traditional HMO.

All of HealthNet plan members have access to online tools that include a health risk questionnaire, a personal health record, a medication center, a wellness site, and cost estimators for pharmacy benefits and medical procedures.