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Plan Profile

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You are here: FEHB Home > 2002 Plan Comparison > Pennsylvania > Plan Profile: Health Net of Pennsylvania

General Information
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Plan Name: Health Net of Pennsylvania
Service Area: Scranton/Wilkes Barre areas
Brochure: PDF Version
Brochure: Text Version
NCQA Accreditation: No
JCAHO Accreditation: No
URAC Accreditation: No
Plan Type: HMO
Enrollment Code-Self: 2K1
Enrollment Code-Self & Family: 2K2
Link to Plan Home Page: http://www.health.net
Telephone: 800/736-2096
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Benefits
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Doctor Care/ Primary Office Visits: $10
Hospital Inpatient Room and Board Charges: None
RX/ Generic/ Retail: $10
RX/ Brand/ Retail: $20
RX/ Brand/ NonFormulary: $35
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Rates
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Non-Postal
___Biweekly Self: $32.29 Self: & Family: $93.62
___Twice Biweekly Self: $64.58 Self: & Family: $187.24
___Monthly Self: $69.97 Self: & Family: $202.84
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Annuitants
___Monthly Self: $69.97 Self: & Family: $202.84
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U.S. Postal Service Employees (Type A)
___Biweekly Self: $14.53 Self: & Family: $53.28
___Monthly Self: $31.49 Self: & Family: $115.44
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U.S. Postal Service Employees (Type B)
___Biweekly Self: $19.94 Self: & Family: $81.89
___Monthly Self: $43.20 Self: & Family: $177.43
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Worker's Compensation Recipients
___Twice Biweekly Self: $64.58 Self: & Family: $187.24
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Certain Temporary Employees
___Biweekly Self: $129.17 Self: & Family: $317.03
___Monthly Self: $279.87 Self: & Family: $686.90
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Former Spouse Enrollees
___Monthly Self: $279.87 Self: & Family: $686.90
___Biweekly Self: $129.17 Self: & Family: $317.03
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Temporary Continuation of Coverage
___Biweekly Self: $131.75 Self: & Family: $323.37
___Monthly Self: $285.47 Self: & Family: $700.64
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FDIC
___Biweekly Self: $14.53 Self: & Family: $53.28
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