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Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements.

Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary.

The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps.

The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services.

In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer.

In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails.

Policy Effective Date and Defined Terms. The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net.

All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.

In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative.

The Policies do not include definitions. All terms are defined by Health Net. Policy Amendment without Notice. Health Net reserves the right to amend the Policies without notice to providers or Members.

The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. No Authorization or Guarantee of Coverage.

The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply.

Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.

Member's Contract Controls Coverage Determinations. Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions.

Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations.

The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage.

In the event the Member's contract also known as the benefit contract, coverage document, or evidence of coverage conflicts with the Policies, the Member's contract shall govern.

Legal and Regulatory Mandates and Requirements The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements.

To improve function; or 2. To create a normal appearance, to the extent possible. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits.

Medicare and Medicaid Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members.

To provide you with the most accurate plans and information in your area, we need to know your location. Your account security is important to us.

For added protection, please add two more security question to your account below. You may add or delete family members during your open enrollment period.

In addition, we will generally accept enrollments for newly eligible members within 30 days after the following events with proper documentation submitted to us:.

Your medical coverage expired on. For your convenience, we have allowed you to access your medical information and data on this site through.

This enrollee's premiums are past due. Coverage will be suspended if premiums remain past due for more than 1 month.

When coverage is suspended, outstanding authorizations for service are no longer valid. And there is no further coverage for any services rendered unless premiums are paid in full by the end of a 3 month grace period.

Please contact us for more information. This enrollee's premiums are more than 1 month past due. Coverage is currently suspended due to non-payment of premiums.

Outstanding authorizations for service are no longer valid. There is no further coverage for any services rendered unless premiums are paid in full by the end of a 3 month grace period.

BillMatrix is Health Net's secure, online payment service. You can make your online payment using your bank account, check, debit card or credit card.

That being said if you have a Password Reset Disk or you know an Administrator account password you will be able to successfully access the system.

If you forget the administrator password and don't have a password reset disk or another administrator account, you won't be able to reset the password.

If there are no other user accounts on the computer, you won't be able to log on to Windows and will need to re-install Windows. How to use a password reset disk to reset your password: If you did not create a password reset disk skip to the next group of troubleshooting.

Click OK when you see this message. Now click on Reset password , and then follow the instructions. Once complete you will have reset your password, and can now successfully login.

How to use an administrator account to reset your password: If you use another administrator account to reset the password, you will permanently lose access to any e-mail message or encrypted files that are on that account.

Select the account with the password you want to change or remove. Some third-party companies claim to be able to circumvent passwords that have been applied to files and features that Microsoft programs use.

For legal reasons, we cannot recommend or endorse any one of these companies. If you want help to break or to reset a password, you can locate and contact a third-party company for this help.

You use such third-party products and services at your own risk. Did this solve your problem?

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