This plan generally replaces your Medicare coverage. You agree to let Health Net manage your Medicare benefits. It is an HMO (health maintenance organization) with a custom network of providers.

Plan changes

Medicare changes

  • Prescription Drug Part D TrOOP (True Out-Of-Pocket) costs will increase from $5,000 to $5,100.
  • Copayments for certain services will increase slightly for low-income subsidy-eligible Medicare enrollees.
  • Federal regulations to close the Medicare Part D 'donut hole' will go into effect, increasing the Coverage Gap Discount Program (CGDP) from 50 percent to 70 percent. These regulations will also remove some exclusions from the CGDP for biosimilar drugs (drugs that are almost identical to the original).

Provider network changes and expansions

  • Envolve Health will replace EyeMed as the plan's provider of vision benefits.
  • UC Blue & Gold members will have access to care in select CVS MinuteClinic walk-in locations, with a $20 copay for routine visits and $0 copay for preventive care.
  • Telehealth services, including visits with psychiatrists, will be available through Teladoc instead of MDLive.

Diabetes prevention

Seniority Plus members can take part in the Solera Health diabetes prevention program, which features:
  • 16 weekly lessons over the span of six months, followed by monthly maintenance sessions
  • One-to-one interactions with a lifestyle health coach
  • In-person classes (within local preferred provider group, Weight Watchers, YMCA, etc.)

Health Benefit Navigator

Health Net's Health Benefit Navigators, a team of 59 dedicated staff available Monday through Friday from 8 a.m. to 8 p.m., will provide enhanced customer service for Health Net Seniority Plus members. Members can speak to a Health Net Navigator at 1-800-539-4072.

How the plan works

  • You choose a primary care physician (PCP) who coordinates your care and refers you to specialists within your designated medical group.
  • You pay a small copayment for prescription drugs and some services.
  • The plan covers the cost of services only if your PCP authorizes them.
  • HMOs provide coverage for services outside of your medical group only in cases of emergency.
  • Health Net provides behavioral health services.
  • The Centers for Medicare and Medicaid Services must approve the service area for each Medicare plan. If your home zip code is outside of the Health Net Seniority Plus service areayou will not be eligible to enroll. Eligible zip codes can change throughout the year. Please contact the Retirement Administration Service Center, Health Net or Medicare.gov if you have a question about the eligibility of a particular zip code.

Best fit for you if:

  • You want lower out-of-pocket costs
  • You like having one doctor manage your care
  • You are comfortable with out-of-network coverage only in emergencies

Plan costs

Retiree plan costs chart »

Typical out-of-pocket costs

  • Office visit/urgent care visit: $20 (preventive care has no charge)
  • Emergency room: $65
  • Hospital stay: $250
  • Prescription drugs: $5 generic; $25 brand name; $40 non-formulary