CommunityCare HMO - Health Net

Health Net of California, Inc. (Health Net) CommunityCare HMO HEALTH-BOOSTING, LOW-PRICED HMOS WITH EXTRA FLEXIBILITY CommunityCare HMO lets small business groups in L.A., Orange and San Diego counties offer a Silver or Bronze level plan – and save! Employees gain the benefits that put health first. And they have more choices because CommunityCare HMOs have fewer restrictions for specialist care and urgent care than other HMOs. Network advantages Tailored medical and pharmacy networks have lower costs while offering a wide range of care options. Over 12,440 physicians and specialists as well as 79 hospitals in the CommunityCare HMO tailored network. Advanced Choice Pharmacy Network, our first tailored pharmacy network, includes CVS, Walmart, Costco, Safeway, Vons, and more1. More ways to access care CommunityCare HMO is an HMO with more flexibility for specialist care and urgent care – plus a range of other care options. Members can: Choose a primary care physician (PCP) contracted with the CommunityCare tailored network to coordinate their care. BROKER COMMUNICATIONS Their PCP can refer to any specialist in the CommunityCare Network. Care doesn’t need to stay within the PCP’s participating provider group (PPG). Seek care at any urgent care facility in the CommunityCare Network – even those outside their PPG. Visit MinuteClinics (available at some CVS locations) for convenient care for common illnesses, wellness screenings, vaccinations, and more. Use Teladoc telehealth services by phone, mobile app or Web 24/7 for a 0 copayment. Teladoc providers can treat many non-emergency common illnesses, such as sinus problems, upper respiratory infections, allergies, bronchitis, and pinkeye. (continued) 1Walgreens is excluded. Coverage for every stage of life

CommunityCare HMO plans Member(s) responsibility Plan name Office Visit (PCP / Specialist) Deductible (single / family) Inpatient hospital Silver 50 501 / 701 1,750 / 3,500 40% Bronze 60 HMO 6300/65 653 / 953 6,300 / 12,600 40% Pharmacy Outpatient Out-of-pocket Emergency surgery Rx drug maximum Rx deductible room (ASC / Tier 1/2/3 (single / family) (single / family) hospital) 151 / 40%2 / 30% / 40% 7,800 / 15,600 40% 250 / 500 40%2 40% / 40% 7,800 / 15,600 40% 500 / 1,000 18 / 40%4 / 40%4 Rx drug Tier 4 40%2 40%4 1 Deductible waived. 2 Maximum copayment after deductible of 250 for an individual prescription of up to a 30-day supply. 3 Visits 1–3: The calendar year deductible is waived (combined between office visits, urgent care, prenatal and postnatal visits, outpatient mental health/substance abuse). Visits 4–unlimited: The calendar year deductible applies. 4Maximum copayment after deductible of 500 for an individual prescription of up to a 30-day supply. There is no limit to how many HMO plans a small group may offer. CommunityCare HMO can be offered on a standalone basis or can be paired with additional tailored network HMO plans in either of our Enhanced Choice A or Enhanced Choice B packages. 2 1 3 1 From our home page (www.healthnet.com), click on ProviderSearch – Find a Doctor. 2 Enter a location (street address, city, county, state, or ZIP code). 3 Further narrow your search by Provider Name/ID/License Number or by Plan/Network. 4 Select type of provider (doctor, hospital, medical group, etc.) to get your results. 5 Finally, you can click on Print Plan Providers to print your search results. 6 You may also select Export Results to obtain a spreadsheet listing of providers by medical group. 4 6 5

Local network – trusted health care partners Building tailored networks of well-respected doctors and hospitals that allow members to access trusted services where they live is one of the things Health Net does best. By partnering with select providers – in conjunction with designing benefits that encourage cost-effective care – the CommunityCare Network creates value and offers lower costs for employers without compromising employee satisfaction. Health Net’s CommunityCare Network features: 79 hospitals More than 300 clinics – Federally Qualified Health Centers, Rural Health Clinics, etc. Full ancillary providers and services 2,664 Direct Network providers in addition to the participating provider groups below Los Angeles County Participating provider groups Access IPA All Care Medical Group, Inc. Allied Pacific of California IPA AltaMed Medical Group – Commerce Associated Hispanic Physicians of Southern California Community Family Care IPA – Los Angeles Direct Network of Southern California Health Care LA, IPA Martin Luther King Jr. Community Medical Group – Compton Omnicare Medical Group Prospect Medical Group Seoul Medical Group, IPA Hospitals Alhambra Hospital Medical Center Beverly Hospital California Hospital Medical Center Centinela Hospital Medical Center Children’s Hospital of Los Angeles Coast Plaza Hospital Community Hospital of Huntington Park Management LLC East Los Angeles Doctors Hospital Emanate Health Foothill Presbyterian Hospital Emanate Health Medical Center Emanate Health Queen of the Valley Hospital Encino Hospital Medical Center Garfield Medical Center Glendale Memorial Hospital and Health Center Good Samaritan Hospital Greater El Monte Community Hospital Hollywood Presbyterian Medical Center Huntington Memorial Hospital Keck Hospital of USC Lakewood Regional Medical Center Little Company of Mary Hospital For an up-to-date list of doctors and hospitals in the Health Net CommunityCare Network, go to www.healthnet.com ProviderSearch. (continued)

Los Angeles County Hospitals (continued) Little Company of Mary Medical Center San Pedro Long Beach Memorial Medical Center Los Angeles Community Hospital Martin Luther King, Jr. Community Hospital Memorial Hospital of Gardena Methodist Hospital of Southern California Miller Children’s Hospital Monterey Park Hospital Norwalk Community Palmdale Regional Medical Center PIH Health Hospital – Downey PIH Health Hospital – Whittier Pomona Valley Hospital Medical Center Providence Holy Cross Medical Center Providence Saint Joseph Medical Center Providence Tarzana Medical Center San Dimas Community Hospital San Gabriel Valley Medical Center Sherman Oaks Hospital Southern California Hospital at Culver City Southern California Hospital at Hollywood St. Francis Medical Center St. Mary Medical Center St. Vincent Medical Center Torrance Memorial Medical Center USC – Kenneth Norris Jr. Cancer Hospital USC Verdugo Hills Hospital LLC Valley Presbyterian Hospital White Memorial Medical Center Whittier Hospital Medical Center Important! This listing is a general guide only and is subject to change. It’s important to note that PPGs and PCPs typically affiliate with specific hospitals. Please confirm that the PPG and/or PCP is affiliated with the hospital listed prior to selecting a PCP. Orange County Participating provider groups AltaMed Health Services IPA – Orange Direct Network of Southern California Prospect Gateway Medical Group Prospect Genesis Health Care Prospect Medical Group Prospect Professional Care Medical Group, Inc. Hospitals AHMC Anaheim Regional Medical Center LP Anaheim Global Medical Center Chapman Global Medical Center Fountain Valley Regional Hospital and Medical Center Garden Grove Hospital Medical Center (continued)

Orange County Hospitals (continued) Huntington Beach Hospital La Palma Intercommunity Hospital Los Alamitos Medical Center Orange Coast Memorial Medical Center Orange County Global Medical Center Placentia Linda Hospital Saddleback Memorial Medical Center South Coast Global Medical Center West Anaheim Medical Center Important! This listing is a general guide only and is subject to change. It’s important to note that PPGs and PCPs typically affiliate with specific hospitals. Please confirm that the PPG and/or PCP is affiliated with the hospital listed prior to selecting a PCP. San Diego County Participating provider groups Arch Health Partners Direct Network of Southern California Greater Tri-Cities IPA – Community Care Primary Care Associated Medical Group Scripps Clinics Scripps Coastal Medical Centers Hospitals Alvarado Hospital Medical Center Palomar Medical Center – Downtown Escondido Palomar Medical Center – Escondido Palomar Medical Center – Poway Paradise Valley Hospital Rady Children’s Hospital – San Diego Scripps Green Hospital Scripps Memorial Hospital – Encinitas Scripps Memorial Hospital – La Jolla Scripps Mercy Hospital Scripps Mercy Hospital – Chula Vista Tri-City Medical Center UCSD Medical Center – Hillcrest UCSD Thornton Hospital Important! This listing is a general guide only and is subject to change. It’s important to note that PPGs and PCPs typically affiliate with specific hospitals. Please confirm that the PPG and/or PCP is affiliated with the hospital listed prior to selecting a PCP. Get a quote today! Find out what CommunityCare HMO can do for your clients in L.A., Orange and San Diego counties. Call your Health Net sales representative. Call your Broker Services team at 1-800-448-4411, option 4. Health Net HMO health plans are offered by Health Net of California, LLC. Health Net of California, Inc. is a subsidiary of Health Net, LLC. Health Net is a registered service mark of Health Net, LLC. All other identified trademarks/service marks remain the property of their respective companies. All rights reserved. FLY030414EL00 (10/19)

Providence Tarzana Medical Center. San Dimas Community Hospital. San Gabriel Valley Medical Center. Sherman Oaks Hospital. Southern California Hospital at Culver City. Southern California Hospital at Hollywood. St. Francis Medical Center. St. Mary Medical Center. St. Vincent Medical Center .