Plan Details

Plan Materials

Download the PDF for your records or you can call 1-800-522-0088 to request a printed copy to be mailed to you.

Summary of Benefits and Coverage

Northern California

Southern California

Pharmacy Benefits

Health Net plans give you generic, brand and specialty tier coverage. The easy-to-use pharmacy programs offer the convenience you want with the value you're looking for.

To determine the cost of a drug, use the formulary list below to identify the drug and the tier under which it is covered. Below are the copays by tier for each of the plans available. To view detailed cost information of a drug by plan option, please click on the Check Drug Cost & Coverage links under the second column below.

Retail prescription drugs	(Generic/brand/non-formulary/specialty)
High option	$10/$35/$60/20% ($200 max) Check Drug Cost & Coverage
Standard option	$15/$35/$65/20% ($200 max) Check Drug Cost & Coverage
Basic option (Southern CA)	$15/$35/$65/20% Check Drug Cost & Coverage
Basic option (Northern CA)	$15/$30/$50/20% Check Drug Cost & Coverage

Mail order prescription drugs	(Generic/brand/non-formulary)
High option	$20/$70/$120
Standard option	$30/$70/$130
Basic option (Southern CA)	$30/$70/$130
Basic option (Northern CA)	$30/$60/$100

Our drug lists are selected by Health Net, along with a team of health care providers. These drugs are included because they are believed to be a key part of a quality treatment program. The drug lists are updated regularly and may change.