What You Need to Know
The UC Blue & Gold HMO plan, offered by Health Net of California Inc, provides in-network access to all six world-class UC academic health centers. Choosing UC Blue & Gold HMO means in-network access to quality care at any UC health center. Members also have access to non-UC providers in the UC Blue & Gold network throughout the state.
The Blue & Gold HMO does not cover services outside California, except for urgent or emergency care.
Have Questions or Need Help?
Call Health Benefit Navigators at (800) 539-4072, Monday through Friday, 8 a.m. to 8 p.m. PT.
How It Works
See the summary of benefits and coverage [PDF] for more coverage details.
No-Cost Preventive Care
Includes services such as screenings, immunizations and exams for you and all covered family members.
What You Pay for Care
Deductible
There is no deductible for covered services.
Copay
You pay a $20 copay for most office visits and other outpatient services.
Out-of-Pocket Maximum
This limits the amount you’ll pay for covered services during the year to a maximum of $1,000 (member) or $3,000 (family). After you meet the out-of-pocket maximum, Health Net pays 100% for most covered services, including prescription drugs, for the rest of the year.
No Surprises
Did you know that if you receive emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing?
Behavioral Health
Medically necessary mental health services and treatment for substance use disorder is administered by MHN Services. Visit the website or call MHN at (800) 663-9355, Monday through Friday, 8 a.m. to 8 p.m. PT.
Prescription Drugs
- Retail: $5 copay for generic; $25 copay for preferred brand; $40 copay for non-preferred brand; $20 copay for specialty.
- Mail order: $10 copay for generic; $50 copay for preferred brand; $80 copay for non-preferred brand.
View details about in-network pharmacies, prescription drug coverage, and more on the Health Net website.
Infertility Support
The journey to parenthood is not always easy. If you are struggling to conceive, Health Net is here to help. UC Blue & Gold HMO members are provided a 2-cycle lifetime maximum benefit toward IVF, GIFT and ZIFT treatment with 50% coinsurance, up to a combined limit of two treatment cycles per lifetime, per member. For more information, see the Family Planning and Maternity Guide [PDF] or call Health Net at Health Benefit Navigators at (800) 539-4072, Monday through Friday, 8:00 a.m. to 8:00 p.m. PT.
Filing Claims
Except for emergencies, only services provided through Health Net and MHN network providers are covered. To file claims for out-of-network emergency care, contact Health Benefit Navigators at (800) 539-4072, Monday–Friday (8 a.m.–5 p.m. PT) or email askblue&gold@healthnet.com.
1 You may receive services on an in-person basis or via telehealth, if available, from your primary care provider, a treating specialist or from another contracting individual health professional, contracting clinic, or contracting health facility consistent with the service and existing timeliness and geographic access standards required under California law. Any cost share for services received through Babylon will accrue toward your out-of-pocket maximum and deductible (if your plan has a deductible). By scheduling through Babylon, you consent to receive services via telehealth through Babylon. See your health plan coverage document for coverage information and for the definition of telehealth services. You have a right to access your medical records for services received through Babylon. Unless you choose otherwise, any services provided through Babylon shall be shared with your primary care provider.
Health Net of California, Inc. is a subsidiary of Health Net, LLC. and Centene Corporation. Health Net, LLC. is a registered service mark of Health Net, LLC. Managed Health Network, LLC (MHN) is a subsidiary of Health Net, LLC and Centene Corporation. The MHN family of companies includes Managed Health Network and MHN Services, LLC. Managed Health Network is a registered service mark of Managed Health Network, LLC. All rights reserved.