Health Net Monthly Premium Rate Guide CA 2011

MONTHLY PREMIUMRATE GUIDE

Effective January 1, 2011

INDIvIDUAL & fAMILY PLANs AND CALIfORNIA fARM BUREAU MEMBERs’HEALTH INsURANCE PLANs

Health insurance coverage made easy

Get your quote online http://www.healthnetworkinsurance.com/ca-get-quote

http://www.healthnetworkinsurance.com/ca-get-quote

TABLE Of CONTENTsMonthly Premium Rates ......................................................................................2

Modified Issue .....................................................................................................2

Medical and Dental Rating Region ......................................................................2

PPO and HSA-Compatible PPO Plans – Rating Regions by County ...................3

HMO Rating Regions by County ........................................................................4

California Farm Bureau Federation 2011 Annual Membership Dues ....................5

Rating Region 1: PPO Health Plans ....................................................................6




Rating Region 5: PPO Health Plans .................................................................. 10





HMO 40 NG: Rating Regions 1 through 8 ....................................................... 15

HMO Counties by Rating Region ..................................................................... 15

Monthly Term Life Insurance Rates ................................................................... 16

IFP Dental and Vision with IFP PPO Plans ....................................................... 16

IFP Dental and Vision with IFP HMO Plans .................................................... 16

Counties Available for Dental and Vision IFP HMO Plus Plans ........................ 16

Farm Bureau CashNet Rates .............................................................................. 17

Farm Bureau Vision Rates ................................................................................. 17

Farm Bureau Dental Rates ................................................................................. 17

Counties Available for Farm Bureau Dental HMO Plan .................................... 17

Health Net Individual & Family HMO health plans are offered by Health Net of California, Inc. Health Net Individual & Family PPO insurance plans, Policy Form # P30601 (CA 1/11), and California Farm Bureau Member’s Health Insurance Plans are underwritten by Health Net Life Insurance Company. Subject to medical underwriting. Health Net of California, Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc.

2

Finding the rate that applies to you is easy:

1. Find the chart for your region on the following pages;

2. Determine your family category;

3. Select your age group. If you are applying as a married couple or a family, use the age category of the younger spouse and make that person the primary applicant on the application; then

4. Select a plan.

PREMIUM PayMEnt oPtIons

• Simplepay(automaticbankdraft)option

• Creditcardbilling

• Monthlybilling

MODIfIED IssUE1

Q: What is a Modified Issue?

A: Modified Issue helps certain applicants who might normally not be able to obtain coverage attain it for a higher premium.

Q: How does Health Net calculate Modified Issue premiums?

A: Modified Issue premiums are calculated by multiplying the preferred premium2 shown in the rate guide by the rate adjustment factor (RAF) which is quoted by Health Net’s Individual & Family Underwriting Department.

1 Applies to PPO plans only. 2 Dental and Vision premium will also be adjusted to include the RAF if you are approved for a PPO Plus plan.

MONTHLY PREMIUM RATEsFaRM BUREaU

California Farm Bureau Members’ Health Insurance Plans are available only to California County Farm Bureau members.

If the applicant is not already a county Farm Bureau member, then he or she has the following options for paying Farm Bureau dues (Sustaining membership type only).

• Pay$72withapplication.AnnualFarmBureauduesthereafter are billed directly by the Farm Bureau.

• Pay$8permonthforFarmBureauduesandprocessing fee. This is billed with their health insurance premium.

See page 5 for annual membership dues.

6

ppO hEALTh pLANS REGION 1 Los Angeles County – ZIP codes beginning with 906–912, 915, 917–918 and 935.

Refer to page 3 for county details. Not all counties are available. The deductibles shown are for an individual only. On the CFB Sensible HSA NG and the Optimum Advantage HSA NG, family deductible is 2x the individual. Rates effective January 1, 2011. Rates subject to change. CFB Budget PPO NG and CFB Sensible HSA NG plans are California Farm Bureau Members’ Health Insurance Plans and are available only to California County Farm Bureau members. If applicant is not already a county Farm Bureau member, include Annual Farm Bureau dues with application. (See Annual Membership dues on page 5.)

CFB Budget PPO NG –

$6,000 Ded


$7,500 Ded

CFB Sensible HSA NG – $5,200 Deductible

ValueNet NG – $4,000 Ded

Optimum Advantage HSA NG – $4,500 Deductible

Age Applicant Only

Applicant Only

Applicant Only

Applicant & Spouse

Applicant & Child

Applicant & Children

FamilyApplicant

OnlyApplicant

OnlyApplicant & Spouse

Applicant & Child


Family

<1 133 114 122 N/A N/A N/A N/A 145 133 N/A N/A N/A N/A1–4 91 79 83 N/A N/A N/A N/A 85 90 N/A N/A N/A N/A

5–18 81 69 73 N/A N/A N/A N/A 78 82 N/A N/A N/A N/A19 65 55 57 114 169 252 309 79 61 122 183 273 334 20 65 55 57 114 169 252 309 79 61 122 183 273 334 21 65 55 57 114 169 252 309 79 61 122 183 273 334 22 65 55 57 114 169 252 309 79 61 122 183 273 334 23 65 55 57 114 169 252 309 79 62 124 184 274 336 24 65 55 57 114 169 252 309 79 62 124 184 274 336 25 66 56 57 114 172 255 312 80 64 128 190 280 344 26 66 56 57 114 172 255 312 80 66 132 190 280 344 27 66 56 57 114 172 255 312 82 66 132 190 280 344 28 67 57 57 114 172 255 312 84 67 134 190 280 344 29 68 58 57 114 172 255 312 86 69 138 192 282 351 30 72 61 66 132 177 260 326 86 74 148 195 285 359 31 74 63 68 136 177 260 327 86 77 154 195 285 362 32 75 64 69 138 177 260 327 87 78 156 195 285 362 33 77 65 71 142 177 260 328 90 79 158 195 285 362 34 79 67 72 144 177 260 331 91 82 164 197 287 369 35 82 70 75 150 177 260 331 92 86 172 197 287 369 36 84 71 77 154 177 260 331 92 88 176 197 287 369 37 87 74 79 158 177 260 332 94 92 184 197 287 374 38 89 76 82 164 177 260 339 100 95 190 197 287 382 39 93 78 85 170 177 260 339 112 99 198 197 287 382 40 103 87 94 188 177 260 349 127 110 220 197 287 397 41 105 89 96 192 177 260 353 135 114 228 200 290 404 42 108 92 99 198 177 260 358 136 117 234 203 293 410 43 113 96 102 204 179 262 364 136 123 246 208 298 421 44 118 100 108 216 182 265 373 139 128 256 211 301 429 45 128 109 117 234 190 273 390 143 140 280 222 312 452 46 135 115 124 248 197 280 404 144 150 300 232 322 472 47 141 119 129 258 202 285 414 149 158 316 240 330 488 48 158 133 144 288 217 300 444 160 183 366 265 355 538 49 174 146 159 318 232 315 474 171 206 412 288 378 584 50 195 167 179 358 252 335 514 190 240 480 322 412 652 51 203 174 186 372 259 342 528 200 249 498 331 421 670 52 216 184 198 396 271 354 552 209 265 530 347 437 702 53 230 195 211 422 284 367 578 214 281 562 363 453 734 54 246 208 224 448 297 380 604 219 297 594 379 469 766 55 250 212 228 456 301 384 612 220 308 616 390 480 788 56 267 225 243 486 316 399 642 231 325 650 407 497 822 57 281 237 257 514 330 413 670 262 344 688 426 516 860 58 297 250 270 540 343 426 696 300 365 730 447 537 902 59 312 263 285 570 358 441 726 342 386 772 468 558 944 60 336 284 306 612 379 462 768 388 440 880 522 612 1,052 61 351 296 320 640 393 476 796 424 461 922 543 633 1,094 62 365 307 332 664 405 488 820 443 480 960 562 652 1,132 63 378 318 344 688 417 500 844 449 496 992 578 668 1,164

64 390 327 356 712 429 512 868 453 509 1,018 591 681 1,190

2

4

3

1

MEDICAL AND DENTAL RATING REGIONs

Medical and dental premiums are calculated based on the subscriber’s home address. Please refer to the counties on pages 3–4 to determine the rating region.

Go to www.healthnet.com and select ProviderSearch to see the HMO providers or PPO preferred providers within our network. If there is a question regarding area availability, please contact your authorized Health Net Broker or call 1-800-909-3447, option 2.

3

PPO AND HsA-COMPATIBLE PPO PLANs – RATING REGIONs BY COUNTYCounty Region

Alameda Region 5Alpine Region 8Amador Region 8Butte Region 8Calaveras Region 8Colusa Region 8Contra Costa Region 5Del Norte Region 8El Dorado – West1 Region 3 El Dorado – All other ZIP codes Region 8Fresno Region 7Glenn Region 8Humboldt Region 8Imperial Region 9Inyo Region 8Kern Region 7Kings Region 7Lake Region 8Lassen Region 8Los Angeles – ZIP codes beginning Region 1 with 906–912, 915, 917–918 and 935Los Angeles – All other Los Angeles Region 2 ZIP codes not listed in Rating Region 1 Madera Region 8Marin Region 5Mariposa Region 8Mendocino Region 8Merced Region 3Modoc Region 8Mono Region 8Monterey Region 8Napa Region 3

County Region

Nevada Region 8Orange Region 6Placer – West1 Region 3Placer – All other ZIP codes Region 8Plumas Region 8Riverside Region 4Sacramento Region 3San Benito Region 8San Bernardino Region 4San Diego Region 6San Francisco Region 5San Joaquin Region 3San Luis Obispo Region 9San Mateo Region 5Santa Barbara Region 4Santa Clara Region 5Santa Cruz Region 5Shasta Region 8Sierra Region 8Siskiyou Region 8Solano Region 5Sonoma Region 3Stanislaus Region 3Sutter Region 8Tehama Region 8Trinity Region 8Tulare Region 3Toulumne Region 8Ventura Region 4Yolo Region 8Yuba Region 8

1 ZIP codes for western El Dorado include: 95613–14, 95619, 95623, 95630, 95643, 95651, 95664, 95667, 95672, 95682 and 95762 only. ZIP codes for western Placer County include: 95602–04, 95648, 95650, 95658, 95661, 95663, 95677–78, 95703, 95722, 95736, 95746–47 and 95765. All other El Dorado and Placer County ZIP codes are Region 8.

4

County Region

Alameda Region 5

Contra Costa Region 5

El Dorado – East1 Region 8

El Dorado – West2 Region 3

Fresno Region 7

Kern Region 7

Kings Region 7Los Angeles – ZIP codes beginning Region 1with 906–912, 915, 917–918 and 935

Los Angeles – All other Los Angeles Region 2ZIP codes not listed in Rating Region 1

Marin Region 8

Merced Region 3

Orange Region 6

Placer – East1 Region 8

Placer – West2 Region 3

HMO RATING REGIONs BY COUNTY

1 ZIP codes for eastern El Dorado include: 95613–14, 95619, 95629, 95633–36, 95643, 95651, 95656, 95664, 95667, 95672, 95682, 95684, 95709, 95720–21, 95726, 95735, 96150–52 and 96154–58 only. ZIP codes for eastern Placer County include: 95631, 95681, 95701, 95703, 95713–15, 95717, 95722, 95724, 95736, 96140–43, 96145, 96148 and 96162 only. See Region 3 for additional El Dorado County and Placer County ZIP codes.

2 ZIP codes for western El Dorado include: 95623, 95630 and 95762 only. ZIP codes for western Placer County include 95602–04, 95648, 95650, 95658, 95661, 95663, 95677–78, 95746–47 and 95765. See Region 8 for additional El Dorado County and Placer County ZIP codes.

County Region

Riverside Region 4

Sacramento Region 3

San Bernardino Region 4

San Diego Region 6

San Francisco Region 5

San Joaquin Region 3

San Mateo Region 5

Santa Clara Region 5

Santa Cruz Region 5

Solano Region 5

Sonoma Region 3

Stanislaus Region 3

Tulare Region 3

Ventura Region 4

Yolo Region 8

5

County Farm Bureau Voting Sustaining

1 Alameda 90.00 72.00

3 Amador 85.00 72.00

4 Butte 125.00 72.00

5 Calaveras 85.00 72.00

6 Colusa 145.00 72.00

7 Contra Costa 90.00 72.00

8 Del Norte 80.00 72.00

9 El Dorado 120.00 72.00

10 Fresno 125.00 72.00

11 Glenn 100.00 72.00

12 Humboldt 110.00 72.00

13 Imperial 200.00 72.00

14 Inyo-Mono 85.00 72.00

15 Kern 170.00 72.00

16 Kings 150.00 72.00

17 Lake 100.00 72.00

18 Lassen 85.00 72.00

19 Los Angeles 100.00 72.00

20 Madera 200.00 72.00

21 Marin 120.00 72.00

22 Mariposa 90.00 72.00

23 Mendocino 105.00 72.00

24 Merced 175.00 72.00

25 Modoc 90.00 72.00

27 Monterey 400.00 72.00

28 Napa 195.00 72.00

29 Nevada 75.00 72.00

CALIfORNIA fARM BUREAU fEDERATION 2011 ANNUAL MEMBERsHIP DUEs

County Farm Bureau Voting Sustaining

30 Orange 160.00 72.00

31 Placer 80.00 72.00

32 Plumas-Sierra 70.00 72.00

33 Riverside 150.00 72.00

34 Sacramento 115.00 72.00

35 San Benito 125.00 72.00

36 San Bernardino 150.00 72.00

37 San Diego 195.00 72.00

39 San Joaquin 225.00 72.00

40 San Luis Obispo 160.00 72.00

41 San Mateo 185.00 72.00

42 Santa Barbara 200.00 72.00

43 Santa Clara 200.00 72.00

44 Santa Cruz 250.00 72.00

45 Shasta 110.00 72.00

47 Siskiyou 115.00 72.00

48 Solano 120.00 72.00

49 Sonoma 155.00 72.00

50 Stanislaus 225.00 72.00

52 Tehama 100.00 72.00

53 Trinity 75.00 72.00

54 Tulare 150.00 72.00

55 Tuolumne 100.00 72.00

56 Ventura 200.00 72.00

57 Yolo 130.00 72.00

58 Yuba-Sutter 150.00 72.00

2011 dues rates are effective January 1, 2011. For Alpine and San Francisco counties, please choose any county Farm Bureau.

A Voting Member is: Any member who, during the current membership year, expects to receive income from actual farming operations, either as an owner, lessor, lessee, or officer, substantial shareholder or full-time employee of such owner, lessor or lessee. A Sustaining Member is: Any member who is not a voting member.

Dues are subject to change. Contact your county Farm Bureau for more information.

6

PPO HEALTH PLANs REGION 1 Los Angeles County – ZIP codes beginning with 906–912, 915, 917–918 and 935.



$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant

OnlyApplicant & spouse

Applicant & Child


family



64 390 327 356 712 429 512 868 453 509 1,018 591 681 1,190

7

PPO HEALTH PLANs Los Angeles County except those ZIP codes in Region 1.

REGION 2


$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 157 133 143 N/A N/A N/A N/A 190 165 N/A N/A N/A N/A

1–4 106 91 97 N/A N/A N/A N/A 105 98 N/A N/A N/A N/A5–18 96 81 87 N/A N/A N/A N/A 98 90 N/A N/A N/A N/A19 76 65 68 136 200 297 365 102 67 134 215 313 380

20 76 65 68 136 200 297 365 102 67 134 215 313 380

21 76 65 68 136 200 297 365 102 67 134 215 313 380 22 76 65 68 136 200 297 365 102 67 134 215 313 380 23 76 65 68 136 200 297 365 102 67 134 215 313 380 24 76 65 68 136 200 297 365 102 67 134 215 313 380 25 78 66 68 136 203 300 368 103 70 140 222 320 390 26 78 66 68 136 203 300 368 103 72 144 222 320 390 27 78 66 68 136 203 300 368 106 72 144 222 320 390 28 80 67 68 136 203 300 368 109 73 146 222 320 390 29 81 68 68 136 203 300 368 110 74 148 223 321 395 30 85 72 78 156 208 305 383 110 84 168 229 327 411 31 88 74 80 160 208 305 384 110 92 184 233 331 423 32 89 75 81 162 208 305 384 112 99 198 236 334 433 33 91 77 84 168 208 305 386 116 102 204 236 334 436 34 93 78 85 170 208 305 390 118 105 210 239 337 442 35 97 82 89 178 208 305 390 119 116 232 239 337 452 36 99 84 90 180 208 305 390 119 120 240 239 337 457 37 103 87 94 188 208 305 392 121 124 248 239 337 461 38 106 89 96 192 208 305 398 129 129 258 245 343 472 39 110 93 100 200 208 305 398 146 135 270 245 343 472 40 121 103 110 220 208 305 410 164 145 290 245 343 484 41 124 105 113 226 208 305 415 174 149 298 245 343 492 42 128 109 117 234 209 306 423 175 157 314 252 350 507 43 133 113 121 242 212 309 430 175 164 328 258 356 520 44 139 118 128 256 216 313 441 180 173 346 265 363 536 45 150 128 137 274 224 321 458 184 181 362 271 369 550 46 161 136 146 292 233 330 476 186 187 374 277 375 562 47 168 141 154 308 241 338 492 192 199 398 289 387 586 48 188 158 171 342 258 355 526 203 221 442 311 409 630 49 207 174 188 376 275 372 560 218 241 482 331 429 670 50 230 195 210 420 297 394 604 241 272 544 362 460 732 51 239 204 220 440 307 404 624 256 282 564 372 470 752 52 256 216 233 466 320 417 650 267 300 600 390 488 788 53 273 230 248 496 335 432 680 274 319 638 409 507 826 54 291 245 266 532 353 450 716 278 338 676 428 526 864 55 298 250 272 544 359 456 728 282 345 690 435 533 878 56 316 267 289 578 376 473 762 296 366 732 456 554 920 57 334 282 304 608 391 488 792 335 386 772 476 574 960 58 352 297 320 640 407 504 824 384 410 820 500 598 1,008 59 372 312 338 676 425 522 860 439 432 864 522 620 1,052 60 400 337 365 730 452 549 914 497 494 988 584 682 1,176 61 418 351 381 762 468 565 946 542 517 1,034 607 705 1,222 62 434 366 396 792 483 580 976 569 537 1,074 627 725 1,262

63 450 379 410 820 497 594 1,004 577 556 1,112 646 744 1,300

64 465 390 423 846 510 607 1,030 583 572 1,144 662 760 1,332


8

PPO HEALTH PLANs Merced, Napa, Sacramento, San Joaquin, Sonoma, Stanislaus, Tulare, western El Dorado, and western Placer counties.

REGION 3



$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 149 132 136 N/A N/A N/A N/A 181 137 N/A N/A N/A N/A1–4 102 89 93 N/A N/A N/A N/A 102 88 N/A N/A N/A N/A5–18 92 79 83 N/A N/A N/A N/A 95 80 N/A N/A N/A N/A19 73 63 65 130 190 283 348 98 60 120 185 273 333 20 73 63 65 130 190 283 348 98 60 120 185 273 333 21 73 63 65 130 190 283 348 98 60 120 185 273 333 22 73 63 65 130 190 283 348 98 60 120 185 273 333 23 73 63 65 130 190 283 348 98 60 120 185 273 333 24 73 63 65 130 190 283 348 98 60 120 185 273 333 25 74 64 65 130 194 287 352 99 63 126 191 279 342 26 74 64 65 130 194 287 352 99 65 130 191 279 342 27 74 64 65 130 194 287 352 102 65 130 191 279 342 28 76 66 65 130 194 287 352 104 66 132 191 279 342 29 77 67 65 130 194 287 352 107 67 134 193 281 348 30 81 71 75 150 199 292 367 107 84 168 207 295 379 31 84 73 77 154 199 292 368 107 85 170 207 295 379 32 85 74 77 154 199 292 368 108 88 176 207 295 381 33 87 75 80 160 199 292 369 110 89 178 207 295 381 34 89 77 81 162 199 292 372 111 91 182 207 295 385 35 92 80 85 170 199 292 372 112 106 212 212 300 406 36 94 82 87 174 199 292 372 113 109 218 212 300 409 37 98 86 89 178 199 292 373 116 113 226 213 301 414 38 101 87 92 184 199 292 381 123 117 234 218 306 423 39 105 91 95 190 199 292 381 139 122 244 218 306 423 40 116 101 106 212 199 292 393 157 133 266 218 306 439 41 119 103 108 216 199 292 397 166 138 276 223 311 449 42 122 106 112 224 199 292 404 167 142 284 226 314 456 43 127 111 115 230 202 295 410 167 150 300 234 322 472 44 132 116 122 244 206 299 421 171 159 318 240 328 487 45 144 125 131 262 214 307 438 176 167 334 247 335 502 46 154 133 139 278 222 315 454 178 173 346 253 341 514 47 160 138 146 292 229 322 468 184 184 368 264 352 536 48 178 155 163 326 246 339 502 195 201 402 281 369 570 49 197 171 180 360 263 356 536 209 215 430 295 383 598 50 220 192 201 402 284 377 578 232 240 480 320 408 648 51 229 200 210 420 293 386 596 245 249 498 329 417 666 52 244 212 222 444 305 398 620 256 265 530 345 433 698 53 260 226 237 474 320 413 650 263 281 562 361 449 730 54 278 240 254 508 337 430 684 267 297 594 377 465 762 55 284 245 259 518 342 435 694 271 309 618 389 477 786 56 301 262 275 550 358 451 726 285 327 654 407 495 822 57 318 277 290 580 373 466 756 320 345 690 425 513 858 58 336 291 305 610 388 481 786 367 367 734 447 535 902 59 354 306 322 644 405 498 820 421 387 774 467 555 942 60 382 330 346 692 429 522 868 477 447 894 527 615 1,062 61 399 344 363 726 446 539 902 520 468 936 548 636 1,104 62 413 359 377 754 460 553 930 546 486 972 566 654 1,140 63 428 371 390 780 473 566 956 552 503 1,006 583 671 1,174

64 442 382 403 806 486 579 982 558 516 1,032 596 684 1,200

9

PPO HEALTH PLANs Riverside, San Bernardino, Santa Barbara and Ventura counties.

REGION 4


$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family



64 420 352 383 766 462 551 934 453 509 1,018 591 681 1,190


10

PPO HEALTH PLANs Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Santa Cruz and Solano counties.

REGION 5



$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 143 128 132 N/A N/A N/A N/A 181 142 N/A N/A N/A N/A1–4 97 86 89 N/A N/A N/A N/A 102 87 N/A N/A N/A N/A5–18 87 76 79 N/A N/A N/A N/A 95 79 N/A N/A N/A N/A19 70 61 61 122 182 271 332 98 59 118 187 274 333 20 70 61 61 122 182 271 332 98 59 118 187 274 333 21 70 61 61 122 182 271 332 98 59 118 187 274 333 22 70 61 61 122 182 271 332 98 59 118 187 274 333 23 70 61 61 122 182 271 332 98 59 118 187 274 333 24 70 61 61 122 182 271 332 98 59 118 187 274 333 25 71 62 61 122 186 275 336 99 61 122 193 280 341 26 71 62 61 122 186 275 336 99 63 126 193 280 341 27 71 62 61 122 186 275 336 102 63 126 193 280 341 28 72 63 61 122 186 275 336 104 65 130 193 280 342 29 73 65 61 122 186 275 336 107 66 132 195 282 348 30 77 69 71 142 190 279 350 107 84 168 210 297 381 31 80 70 73 146 190 279 352 107 85 170 210 297 381 32 81 71 73 146 190 279 352 108 88 176 210 297 382 33 82 73 76 152 190 279 352 110 89 178 210 297 382 34 85 75 77 154 190 279 356 111 91 182 210 297 386 35 88 78 81 162 190 279 356 112 102 204 210 297 398 36 90 79 82 164 190 279 356 113 106 212 210 297 402 37 93 83 85 170 190 279 357 116 109 218 210 297 405 38 96 85 88 176 190 279 365 123 114 228 215 302 416 39 100 88 91 182 190 279 365 139 119 238 215 302 416 40 110 97 100 200 190 279 373 157 124 248 215 302 420 41 113 100 103 206 190 279 379 166 130 260 215 302 431 42 116 103 106 212 190 279 384 167 134 268 217 304 438 43 121 107 109 218 192 281 390 167 141 282 224 311 452 44 126 112 116 232 196 285 401 171 148 296 228 315 463 45 137 121 125 250 204 293 418 176 167 334 246 333 500 46 145 129 133 266 212 301 434 178 173 346 252 339 512 47 152 133 138 276 217 306 444 184 184 368 263 350 534 48 170 149 156 312 235 324 480 195 202 404 281 368 570 49 187 165 171 342 250 339 510 209 217 434 296 383 600 50 209 186 192 384 271 360 552 232 243 486 322 409 652 51 218 194 200 400 279 368 568 245 253 506 332 419 672 52 232 205 212 424 291 380 592 256 269 538 348 435 704 53 246 219 226 452 305 394 620 263 285 570 364 451 736 54 265 233 241 482 320 409 650 267 302 604 381 468 770 55 270 238 245 490 324 413 658 271 300 600 381 468 770 56 287 253 262 524 341 430 692 285 316 632 395 482 798 57 302 268 276 552 355 444 720 320 335 670 414 501 836 58 319 281 290 580 369 458 748 367 356 712 435 522 878 59 336 296 306 612 385 474 780 421 376 752 455 542 918 60 363 319 330 660 409 498 828 477 428 856 507 594 1,022 61 379 333 344 688 423 512 856 520 448 896 527 614 1,062 62 393 346 358 716 437 526 884 546 466 932 545 632 1,098 63 407 359 371 742 450 539 910 552 481 962 560 647 1,128

64 420 370 383 766 462 551 934 558 494 988 573 660 1,154

11

PPO HEALTH PLANs Orange and San Diego counties.REGION 6


$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family



64 416 349 379 758 458 547 926 487 509 1,018 591 681 1,190


12

PPO HEALTH PLANs Fresno, Kern and Kings counties.REGION 7



$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 145 125 133 N/A N/A N/A N/A 145 137 N/A N/A N/A N/A

1–4 99 85 90 N/A N/A N/A N/A 85 94 N/A N/A N/A N/A5–18 89 75 80 N/A N/A N/A N/A 78 86 N/A N/A N/A N/A19 71 60 62 124 184 274 336 79 64 128 190 284 348 20 71 60 62 124 184 274 336 79 64 128 190 284 348 21 71 60 62 124 184 274 336 79 64 128 190 284 348 22 71 60 62 124 184 274 336 79 64 128 190 284 348 23 71 60 62 124 184 274 336 79 64 128 190 284 348 24 71 60 62 124 184 274 336 79 64 128 190 284 348 25 72 60 62 124 188 278 340 80 67 134 197 291 358 26 72 60 62 124 188 278 340 80 68 136 197 291 358 27 72 60 62 124 188 278 340 82 69 138 197 291 358 28 73 62 62 124 188 278 340 84 70 140 197 291 358 29 74 63 62 124 188 278 340 86 71 142 199 293 364 30 79 67 72 144 192 282 354 86 89 178 214 308 397 31 81 69 74 148 192 282 356 86 90 180 214 308 397 32 82 70 75 150 192 282 356 87 92 184 214 308 398 33 84 71 78 156 192 282 359 90 95 190 214 308 401 34 86 73 79 158 193 283 362 91 96 192 215 309 405 35 89 76 82 164 193 283 362 92 106 212 216 310 416 36 91 78 84 168 193 283 362 92 109 218 216 310 419 37 95 80 87 174 193 283 363 94 113 226 218 312 425 38 98 83 89 178 193 283 369 100 117 234 223 317 434 39 101 86 93 186 193 283 369 112 122 244 223 317 435 40 112 95 102 204 193 283 379 127 133 266 224 318 451 41 115 97 105 210 193 283 385 135 138 276 229 323 461 42 118 100 108 216 193 283 390 136 142 284 232 326 468 43 123 105 111 222 195 285 396 136 150 300 239 333 483 44 128 109 118 236 199 289 407 139 159 318 246 340 499 45 139 118 127 254 207 297 424 143 167 334 253 347 514 46 148 125 134 268 214 304 438 144 173 346 259 353 526 47 155 130 141 282 221 311 452 149 184 368 270 364 548 48 173 145 158 316 238 328 486 160 201 402 287 381 582 49 190 161 174 348 254 344 518 171 215 430 301 395 610 50 213 181 195 390 275 365 560 190 240 480 326 420 660 51 222 189 203 406 283 373 576 200 249 498 335 429 678 52 236 200 215 430 295 385 600 209 265 530 351 445 710 53 250 213 229 458 309 399 628 214 281 562 367 461 742 54 269 227 245 490 325 415 660 219 297 594 383 477 774 55 275 231 249 498 329 419 668 220 309 618 395 489 798 56 292 246 266 532 346 436 702 231 327 654 413 507 834 57 308 260 281 562 361 451 732 262 345 690 431 525 870 58 325 274 295 590 375 465 760 300 367 734 453 547 914 59 342 288 311 622 391 481 792 342 387 774 473 567 954 60 369 310 335 670 415 505 840 388 447 894 533 627 1,074 61 386 324 350 700 430 520 870 424 468 936 554 648 1,116 62 400 336 365 730 445 535 900 443 486 972 572 666 1,152 63 414 348 377 754 457 547 924 449 503 1,006 589 683 1,186

64 427 359 390 780 470 560 950 453 516 1,032 602 696 1,212

13

PPO HEALTH PLANs

Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, eastern El Dorado, eastern Placer, Glenn, Humboldt, Inyo, Lake, Lassen, Madera, Mariposa, Mendocino, Modoc, Mono, Monterey, Nevada, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yolo and Yuba counties.

REGION 8


$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 192 164 176 N/A N/A N/A N/A 204 184 N/A N/A N/A N/A1–4 129 109 117 N/A N/A N/A N/A 116 117 N/A N/A N/A N/A5–18 119 99 107 N/A N/A N/A N/A 109 109 N/A N/A N/A N/A19 95 79 83 166 244 361 444 110 81 162 248 365 446 20 95 79 83 166 244 361 444 110 81 162 248 365 446 21 95 79 83 166 244 361 444 110 81 162 248 365 446 22 95 79 83 166 244 361 444 110 81 162 248 365 446 23 95 79 83 166 244 361 444 110 81 162 248 365 446 24 95 79 83 166 244 361 444 110 81 162 248 365 446 25 96 81 83 166 249 366 449 111 84 168 256 373 457 26 96 81 83 166 249 366 449 111 87 174 256 373 457 27 96 81 83 166 249 366 449 116 87 174 256 373 457 28 98 82 83 166 249 366 449 119 89 178 256 373 458 29 100 84 83 166 249 366 449 120 90 180 259 376 466 30 105 89 96 192 255 372 468 120 98 196 263 380 478 31 108 91 99 198 255 372 471 120 101 202 263 380 480 32 110 92 100 200 255 372 471 121 103 206 263 380 480 33 112 95 103 206 255 372 472 124 106 212 263 380 483 34 115 97 105 210 256 373 478 128 108 216 263 380 488 35 120 101 109 218 256 373 478 129 119 238 263 380 497 36 122 103 112 224 256 373 478 129 122 244 263 380 500 37 127 107 116 232 256 373 481 131 127 254 263 380 506 38 131 110 119 238 256 373 489 139 132 264 269 386 518 39 136 114 124 248 256 373 489 159 137 274 269 386 518 40 149 126 136 272 256 373 503 177 147 294 269 386 526 41 154 129 140 280 256 373 510 189 155 310 270 387 542 42 158 134 143 286 256 373 515 190 160 320 274 391 551 43 165 139 149 298 260 377 526 190 162 324 275 392 554 44 173 146 158 316 267 384 542 195 162 324 275 392 554 45 187 158 170 340 277 394 564 198 163 326 275 392 554 46 198 168 180 360 287 404 584 201 167 334 276 393 560 47 207 174 189 378 296 413 602 207 178 356 287 404 582 48 231 195 211 422 318 435 646 221 204 408 313 430 634 49 256 215 232 464 339 456 688 236 228 456 337 454 682 50 283 239 259 518 366 483 742 261 262 524 371 488 750 51 295 249 270 540 377 494 764 276 271 542 380 497 768 52 314 266 287 574 394 511 798 287 289 578 398 515 804 53 335 283 306 612 413 530 836 295 306 612 415 532 838 54 360 303 327 654 434 551 878 301 325 650 434 551 876 55 369 309 335 670 442 559 894 304 338 676 447 564 902 56 392 329 357 714 464 581 938 320 359 718 468 585 944 57 414 348 377 754 484 601 978 363 380 760 489 606 986 58 437 367 397 794 504 621 1,018 415 402 804 511 628 1,030 59 461 387 419 838 526 643 1,062 476 424 848 533 650 1,074 60 497 417 451 902 558 675 1,126 538 474 948 583 700 1,174 61 519 435 472 944 579 696 1,168 589 498 996 607 724 1,222 62 539 453 491 982 598 715 1,206 618 517 1,034 626 743 1,260 63 559 470 508 1,016 615 732 1,240 625 535 1,070 644 761 1,296

64 577 484 525 1,050 632 749 1,274 631 550 1,100 659 776 1,326


14

PPO HEALTH PLANs Imperial and San Luis Obispo counties.REGION 9



$6,000 Ded


$7,500 Ded




Age Applicant Only

Applicant Only

Applicant Only

Applicant & spouse

Applicant & Child


familyApplicant

OnlyApplicant


Applicant & Child


family

<1 192 164 176 N/A N/A N/A N/A 204 184 N/A N/A N/A N/A1–4 129 109 117 N/A N/A N/A N/A 116 117 N/A N/A N/A N/A5–18 119 99 107 N/A N/A N/A N/A 109 109 N/A N/A N/A N/A19 95 79 83 166 244 361 444 110 81 162 248 365 446 20 95 79 83 166 244 361 444 110 81 162 248 365 446 21 95 79 83 166 244 361 444 110 81 162 248 365 446 22 95 79 83 166 244 361 444 110 81 162 248 365 446 23 95 79 83 166 244 361 444 110 81 162 248 365 446 24 95 79 83 166 244 361 444 110 81 162 248 365 446 25 96 81 83 166 249 366 449 111 84 168 256 373 457 26 96 81 83 166 249 366 449 111 87 174 256 373 457 27 96 81 83 166 249 366 449 116 87 174 256 373 457 28 98 82 83 166 249 366 449 119 89 178 256 373 458 29 100 84 83 166 249 366 449 120 90 180 259 376 466 30 105 89 96 192 255 372 468 120 98 196 263 380 478 31 108 91 99 198 255 372 471 120 101 202 263 380 480 32 110 92 100 200 255 372 471 121 103 206 263 380 480 33 112 95 103 206 255 372 472 124 106 212 263 380 483 34 115 97 105 210 256 373 478 128 108 216 263 380 488 35 120 101 109 218 256 373 478 129 119 238 263 380 497 36 122 103 112 224 256 373 478 129 122 244 263 380 500 37 127 107 116 232 256 373 481 131 127 254 263 380 506 38 131 110 119 238 256 373 489 139 132 264 269 386 518 39 136 114 124 248 256 373 489 159 137 274 269 386 518 40 149 126 136 272 256 373 503 177 147 294 269 386 526 41 154 129 140 280 256 373 510 189 155 310 270 387 542 42 158 134 143 286 256 373 515 190 160 320 274 391 551 43 165 139 149 298 260 377 526 190 162 324 275 392 554 44 173 146 158 316 267 384 542 195 162 324 275 392 554 45 187 158 170 340 277 394 564 198 163 326 275 392 554 46 198 168 180 360 287 404 584 201 167 334 276 393 560 47 207 174 189 378 296 413 602 207 178 356 287 404 582 48 231 195 211 422 318 435 646 221 204 408 313 430 634 49 256 215 232 464 339 456 688 236 228 456 337 454 682 50 283 239 259 518 366 483 742 261 262 524 371 488 750 51 295 249 270 540 377 494 764 276 271 542 380 497 768 52 314 266 287 574 394 511 798 287 289 578 398 515 804 53 335 283 306 612 413 530 836 295 306 612 415 532 838 54 360 303 327 654 434 551 878 301 325 650 434 551 876 55 369 309 335 670 442 559 894 304 338 676 447 564 902 56 392 329 357 714 464 581 938 320 359 718 468 585 944 57 414 348 377 754 484 601 978 363 380 760 489 606 986 58 437 367 397 794 504 621 1,018 415 402 804 511 628 1,030 59 461 387 419 838 526 643 1,062 476 424 848 533 650 1,074 60 497 417 451 902 558 675 1,126 538 474 948 583 700 1,174 61 519 435 472 944 579 696 1,168 589 498 996 607 724 1,222 62 539 453 491 982 598 715 1,206 618 517 1,034 626 743 1,260 63 559 470 508 1,016 615 732 1,240 625 535 1,070 644 761 1,296

64 577 484 525 1,050 632 749 1,274 631 550 1,100 659 776 1,326

15

HMO 40 NGhmo 40 NG

tier aGe reGioN 1 reGioN 2 reGioN 3 reGioN 4 reGioN 5 reGioN 6 reGioN 7 reGioN 8

subscriber <1 906 906 976 992 1,116 996 994 1,012 1–4 244 244 263 257 294 257 272 285

5–18 236 236 255 249 286 249 264 277 19–24 292 292 313 316 356 316 325 345 25–29 341 341 365 366 419 366 383 411 30–34 428 428 465 471 529 465 487 525 35–39 472 472 507 513 580 507 536 570 40–44 496 496 535 544 608 535 557 597 45–49 523 523 564 574 646 565 593 623 50–54 618 618 663 674 749 666 695 727 55–59 722 722 774 788 886 782 808 853 60–64 722 722 774 788 886 782 808 853

subscriber & spouse/domestic partNer

19–24 584 584 626 632 712 632 650 690 25–29 682 682 730 732 838 732 766 822 30–34 856 856 930 942 1,058 930 974 1,050 35–39 944 944 1,014 1,026 1,160 1,014 1,072 1,140 40–44 992 992 1,070 1,088 1,216 1,070 1,114 1,194 45–49 1,046 1,046 1,128 1,148 1,292 1,130 1,186 1,246 50–54 1,236 1,236 1,326 1,348 1,498 1,332 1,390 1,454 55–59 1,444 1,444 1,548 1,576 1,772 1,564 1,616 1,706 60–64 1,444 1,444 1,548 1,576 1,772 1,564 1,616 1,706

subscriber & child

19–24 567 567 609 607 689 608 631 664 25–29 615 615 660 657 751 657 688 729 30–34 701 701 760 761 860 755 791 842 35–39 744 744 801 802 910 796 839 887 40–44 768 768 828 832 938 823 860 913 45–49 794 794 856 861 975 853 895 938 50–54 854 854 918 923 1,035 915 959 1,004 55–59 958 958 1,029 1,037 1,172 1,031 1,072 1,130 60–64 958 958 1,029 1,037 1,172 1,031 1,072 1,130

subscriber & childreN

19–24 808 808 869 862 980 862 900 946 25–29 855 855 920 910 1,041 910 956 1,011 30–34 941 941 1,018 1,013 1,150 1,008 1,059 1,123 35–39 983 983 1,059 1,054 1,199 1,048 1,106 1,166 40–44 1,006 1,006 1,085 1,083 1,226 1,074 1,126 1,192 45–49 1,031 1,031 1,112 1,112 1,262 1,103 1,160 1,216 50–54 1,090 1,090 1,173 1,172 1,321 1,164 1,223 1,281 55–59 1,194 1,194 1,284 1,286 1,458 1,280 1,336 1,407 60–64 1,194 1,194 1,284 1,286 1,458 1,280 1,336 1,407

family 19–24 1,100 1,100 1,182 1,178 1,336 1,178 1,225 1,291 25–29 1,196 1,196 1,285 1,276 1,460 1,276 1,339 1,422 30–34 1,369 1,369 1,483 1,484 1,679 1,473 1,546 1,648 35–39 1,455 1,455 1,566 1,567 1,779 1,555 1,642 1,736 40–44 1,502 1,502 1,620 1,627 1,834 1,609 1,683 1,789 45–49 1,554 1,554 1,676 1,686 1,908 1,668 1,753 1,839 50–54 1,708 1,708 1,836 1,846 2,070 1,830 1,918 2,008 55–59 1,916 1,916 2,058 2,074 2,344 2,062 2,144 2,260 60–64 1,916 1,916 2,058 2,074 2,344 2,062 2,144 2,260

HMO rates effective January 1, 2011. Rates subject to change.

HMO COUNTIEs BY RATING REGIONsregion 1 Los Angeles County – ZIP codes beginning with 906–912, 915, 917–918 and 935.region 2 Los Angeles County except those ZIP codes in Region 1.region 3 Merced, Sacramento, San Joaquin, Sonoma, Stanislaus, Tulare, western El Dorado County – ZIP codes include 95623, 95630 and 95762 only;

western Placer County – ZIP codes include 95602–04, 95648, 95650, 95658, 95661, 95663, 95677–78, 95746–47 and 95765.region 4 Riverside, San Bernardino and Ventura counties.region 5 Alameda, Contra Costa, San Francisco, San Mateo, Santa Clara, Santa Cruz and Solano counties.region 6 Orange and San Diego counties.region 7 Fresno, Kern and Kings counties.region 8 Eastern El Dorado – ZIP codes include 95613–14, 95619, 95629, 95633–36, 95643, 95651, 95656, 95664, 95667, 95672, 95682, 95684, 95709,

95720–21, 95726, 95735, 96150–52 and 96154–58 only; eastern Placer County – ZIP codes include 95631, 95681, 95701, 95703, 95713–15, 95717, 95722, 95724, 95736, 96140–43, 96145, 96148 and 96162 only; Marin and Yolo counties.

REGIONS 1–8

16

INDIvIDUAL TERM LIfE INsURANCE fOR fARM BUREAU AND INDIvIDUAL & fAMILY PLANs (IfP)

Health Net Life Insurance Company is pleased to offer affordable Individual Term Life Insurance in thefollowingamounts:$10,000,$20,000,$30,000,$40,000and$50,000.Youcanpurchaseapolicyforyourself, your spouse and/or a dependent.

Monthly tERM lIFE InsURancE RatEs

• Ifyouwishtopurchaselifeinsurance,youmustpurchaseaminimumcoverageof$10,000.

• Themaximumlifeinsurancebenefitis$50,000.

• TermLifeInsuranceisnotavailableforapplicantsapplying for HIPAA guaranteed issue coverage, or for those being offered modified issue plans or Quick Net plans.

IfP DENTAL AND vIsION

PPO insurance plans, Policy Form #P30601 (CA 1/11), Individual Term Life Insurance and PPO dental and vision benefits are underwritten by Health Net Life Insurance Company. HMO dental and vision plans are offered by Health Net of California, Inc. Dental benefits are administered by Dental Benefit Administrative Services, and vision benefits are administered by EyeMed Vision Care, LLC. Dental Benefit Administrative Services and EyeMed Vision Care, LLC are not affiliated with Health Net Life Insurance Company.

1 A Health Net “Plus” plan is a Health Net HMO or PPO Plan with Health Net dental and vision coverage included. The “Plus” indicates the addition of the optional coverage.

2 These ZIP codes do not have coverage: El Dorado 95720–21, 95735, 96150–58; Fresno 93210, 93234, 93603, 93605, 93621, 93628–29, 93633–34, 93641–42, 93664, 93675; Kern 93205, 93222, 93225–26, 93238, 93240, 93255, 93283, 93285, 93527–28, 93554, 93556, 93558; Merced 93620, 93635, 93661, 93665, 95317, 95322, 95333, 95340–41, 95365; Riverside 92225–26, 92239; San Bernardino 92242, 92267, 92280, 92304, 92310, 92319, 92323, 92332, 92338, 92363, 92366, 93555, 93562, 93592; San Diego 91905–06, 91934, 91962, 92004, 92066, 92086; Sonoma 95412, 95425, 95480, 95497; Tulare 93208, 93237, 93260, 93262, 93265, 93271

3 ZIP codes for eastern Placer County include: 95631, 95681, 95703, 95713, 95717, 95722, 95736 and 96162 only. See page 4 for additional Placer County ZIP codes.

4 ZIP codes for western Placer County include: 95602–04, 95648, 95650, 95658, 95661, 95663, 95677–78, 95746–47 and 95765. See page 4 for additional Placer County ZIP codes.

This list is subject to change.

available with all ppo plus1 plaNs

Applicant $25

Applicant and spouse/ $50 domestic partner

Applicant and child $50

Applicant and children $75

family $100

dEntal and vIsIon wIth hEalth nEt PPo Plans

available with all hmo plus1 plaNs

subscriber $9

subscriber and spouse/ $18 domestic partner

subscriber and child $18

subscriber and children $27

family $36

dEntal and vIsIon wIth hEalth nEt hMo Plans

coUntIEs avaIlaBlE FoR dEntal and vIsIon hMo PlUs1 Plans

AlamedaContra CostaEl Dorado2 Fresno2

Kern2

Los AngelesMarin

Merced2

OrangePlacer – East3

Placer – West4

Riverside2

SacramentoSan Bernardino2

San Diego2

San FranciscoSan JoaquinSan MateoSanta ClaraSanta CruzSolano

Sonoma2

StanislausTulare2

VenturaYolo

aGe $10,000 $20,000 $30,000 $40,000 $50,000

1–17 $1.00 N/A N/A N/A N/A

18–29 $1.90 $3.80 $5.70 $7.60 $9.50

30–39 $2.40 $4.80 $7.20 $9.60 $12.00

40–49 $5.00 $10.00 $15.00 $20.00 $25.00

50–59 $13.70 $27.40 $41.10 $54.80 $68.50

60–64 $20.00 $40.00 $60.00 $80.00 $100.00

17

vIsIon RatEs

Monthly rates effective 1/1/06. Rates subject to change.

ppo visioN plaN

member $13.66

member +1 $26.65

member +2 or more $38.25

fARM BUREAUcashnEt RatEsApplicable to all regions.


dEntal RatEs


hmoscheduled

reimbursemeNt plaN

member $20.00 $39.00

member +1 $38.00 $78.01

member +2 or more $58.00 $111.16

coUntIEs avaIlaBlE FoR FaRM BUREaU dEntal hMo Plan

1These ZIP codes do not have coverage:

El Dorado 95720–21, 95735, 96150–58;

Fresno 93210, 93234, 93603, 93605, 93621, 93628–29, 93633–34, 93641–42, 93664, 93675;

Kern 93205, 93222, 93225–26, 93238, 93240, 93255, 93283, 93285, 93527–28, 93554,

93556, 93558;

Madera 93601, 93604, 93643–44, 93669;

Merced 93620, 93635, 93661, 93665, 95317, 95322, 95333, 95340–41, 95365;

Monterey 93920, 93927–28, 93930, 93932, 93954, 93960;

Placer 95701, 95714–15, 95724, 96140–43, 96145–46, 96148;

Riverside 92225–26, 92239;

San Bernardino 92242, 92267, 92280, 92304, 92310, 92319, 92323, 92332, 92338, 92363,

92366, 93555, 93562, 93592;

San Diego 91905–06, 91934, 91962, 92004, 92066, 92086;

Sonoma 95412, 95425, 95480, 95497;

Tulare 93208, 93237, 93260, 93262, 93265, 93271.

This list is subject to change.

tier aGe

applicaNt 19–24 16.77

25–29 13.49

30–34 14.00

35–39 14.51

40–44 15.91

45–49 12.97

50–54 15.10

55–59 16.83

60–64 17.75

applicaNt & spouse/domestic partNer

19–24 33.31

25–29 26.75

30–34 27.82

35–39 28.56

40–44 30.75

45–49 24.91

50–54 29.05

55–59 31.84

60–64 33.79

applicaNt & child

19–24 33.39

25–29 30.10

30–34 30.61

35–39 31.13

40–44 32.52

45–49 29.58

50–54 31.71

55–59 33.44

60–64 34.36

applicaNt & childreN

19–24 54.15

25–29 50.87

30–34 51.38

35–39 51.89

40–44 53.28

45–49 50.34

50–54 52.48

55–59 54.20

60–64 55.13

family 19–24 70.69

25–29 64.13

30–34 65.20

35–39 65.94

40–44 68.13

45–49 62.28

50–54 66.42

55–59 69.21

60–64 71.17

child(reN) oNly

1 Child < 1 3.72

1 Child 1–18 1.63

2 Children 3.26

3+ Children 5.00

California Farm Bureau Members’ Health Insurance Plans are underwritten by Health Net Life Insurance Company. Health Net Dental HMO plans are provided by Dental Benefit Providers of California, Inc. (“DBP”). Health Net Dental PPO and indemnity plans are underwritten by Unimerica Life Insurance Company. Obligations of DBP and Unimerica Life Insurance Company are not the obligations of or guaranteed by Health Net, Inc. or its affiliates. Health Net Vision is underwritten by Fidelity Security Life Insurance Company and administered by EyeMed Vision Care, LLC. Fidelity Security Life Insurance Company policy number VC-75, form number C-9069CA.

AlamedaButteContra CostaEl Dorado1

Fresno1

Kern1

Los AngelesMadera1

MarinMerced1

Monterey1

NapaOrangePlacer1

Riverside1

SacramentoSan Bernardino1

San Diego1

San FranciscoSan JoaquinSan Luis ObispoSan Mateo

Santa BarbaraSanta ClaraSanta CruzSolanoSonoma1

StanislausSutterTulare1

VenturaYoloYuba

The CashNet Plan is a supplement to health insurance. It is not a substitute for hospital or medical expense insurance, a health maintenance organization (HMO) contract or major medical expense insurance. It is available with currently marketed Health Net CFB Sensible HSA NG and CFB Budget PPO NG health plans, offered through the California Farm Bureau Members’ Health Insurance Program. Payment is subject to all other terms of the policy. Please refer to the Certificate of Insurance for a list of exclusions and limitations. The CashNet Plan is not available to Medicare Supplement plan enrollees. The CashNet Plan is underwritten by Health Net Life Insurance Company.

CA77369 (1/11) Health Net Individual & Family HMO health plans are offered by Health Net of California, Inc. Health Net Individual & Family PPO insurance plans, Policy Form # P30601 (CA 1/11), and California Farm Bureau Member’s Health Insurance Plans are underwritten by Health Net Life Insurance Company. Subject to medical underwriting. Health Net of California Inc. and Health Net Life Insurance Company are subsidiaries of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved.

For more information please contact:

Health Net PO Box 1150 Rancho Cordova, CA 95741-1150

Individual & Family Plans: 1-800-909-3447

Telecommunications device for the hearing and speech impaired: 1-800-995-0852

www.healthnetworkkinsurance.com

http://www.healthnetworkinsurance.com/ca-get-quote

Documents

Health Net Monthly Premium Rate Guide CA 2011