Health Net

Local affordable health insurance that helps keep people healthy and companies growing. It is our mission to help people be healthy, secure and comfortable.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
Small Group Business Submission Checklist
01/01/2021 Download
Employer Application 1.24
01/01/2024 Download
Employer Application 1.23
01/01/2023 Download
Electronic Check Form
01/01/2024 Download
Group Size Attestation Form
11/01/2023 Download
Proof of Eligibility Statement for Sole Proprietor, Partner or Corporate Officer
02/01/2024 Download
Religious Organization Exemption Form
11/01/2023 Download
In Force Group Forms
Renewal Plan Election & Open Enrollment Change Form 1.24
01/01/2024 Download
Renewal Plan Election & Open Enrollment Change Form 1.23
01/01/2023 Download
Ancillary Add-On or Change Form
07/01/2022 Download
Administration
Welcome To Health Net Employer Guide
02/01/2024 Download
EFT Online Set Up Instructions
07/01/2022 Download
Registering as a Client Administrator Flyer
07/01/2022 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment/Change Form 1.24
01/01/2024 Download
Employee Enrollment/Change Form 1.23
11/01/2023 Download
Understanding the Continuity of Care Assistance Policy
07/01/2022 Download
Continuity of Care Assistance Form
07/01/2022 Download
Prescription Transition Form
07/01/2022 Download
Life Insurance Employee Enrollment/Change Form
07/01/2022 Download
Evidence of Insurability Form
07/01/2022 Download
Claim Forms
Authorization to Use and Disclose Health Information
07/01/2022 Download
Medical Claim Form
07/01/2022 Download
Prescription Transition of Care Form
11/01/2023 Download
Prescription Drug Claim Form
07/01/2022 Download
Dental Claim Form
07/01/2022 Download
Vision Claim Form
07/01/2022 Download
Form Name Effective Date Download Form
2024 Medical HMO
Full Network HMO
Full Network HMO Platinum $0
01/01/2024 Summary SBC
Full Network HMO Platinum $0 INF
01/01/2024 SBC
Full Network HMO Platinum $10
01/01/2024 Summary SBC
Full Network HMO Platinum $10 INF
01/01/2024 SBC
Full Network HMO Platinum $20
01/01/2024 Summary SBC
Full Network HMO Platinum $20 INF
01/01/2024 SBC
Full Network HMO Platinum $30
01/01/2024 Summary SBC
Full Network HMO Platinum $30 INF
01/01/2024 SBC
Full Network HMO Platinum $35
01/01/2024 Summary SBC
Full Network HMO Platinum $35 INF
01/01/2024 SBC
Full Network HMO Gold $30
01/01/2024 Summary SBC
Full Network HMO Gold $30 INF
01/01/2024 SBC
Full Network HMO Gold $35
01/01/2024 Summary SBC
Full Network HMO Gold $35 INF
01/01/2024 SBC
Full Network HMO Gold $40
01/01/2024 Summary SBC
Full Network HMO Gold $40 INF
01/01/2024 SBC
Full Network HMO Gold $50
01/01/2024 Summary SBC
Full Network HMO Gold $50 INF
01/01/2024 SBC
Full Network HMO Gold $55
01/01/2024 Summary SBC
Full Network HMO Gold $55 INF
01/01/2024 SBC
Full Network HMO Silver $55
01/01/2024 Summary SBC
Full Network HMO Silver $55 INF
01/01/2024 SBC
WholeCare HMO Network
WholeCare HMO Platinum $0
01/01/2024 Summary SBC
WholeCare HMO Platinum $0 INF
01/01/2024 SBC
WholeCare HMO Platinum $10
01/01/2024 Summary SBC
WholeCare HMO Platinum $10 INF
01/01/2024 SBC
WholeCare HMO Platinum $20
01/01/2024 Summary SBC
WholeCare HMO Platinum $20 INF
01/01/2024 SBC
WholeCare HMO Platinum $30
01/01/2024 Summary SBC
WholeCare HMO Platinum $30 INF
01/01/2024 SBC
WholeCare HMO Platinum $35
01/01/2024 Summary SBC
WholeCare HMO Platinum $35 INF
01/01/2024 SBC
WholeCare HMO Gold $30
01/01/2024 Summary SBC
WholeCare HMO Gold $30 INF
01/01/2024 SBC
WholeCare HMO Gold $35
01/01/2024 Summary SBC
WholeCare HMO Gold $35 INF
01/01/2024 SBC
WholeCare HMO Gold $40
01/01/2024 Summary SBC
WholeCare HMO Gold $40 INF
01/01/2024 SBC
WholeCare HMO Gold $50
01/01/2024 Summary SBC
WholeCare HMO Gold $50 INF
01/01/2024 SBC
WholeCare HMO Gold $55
01/01/2024 Summary SBC
WholeCare HMO Gold $55 INF
01/01/2024 SBC
WholeCare HMO Silver $55
01/01/2024 Summary SBC
WholeCare HMO Silver $55 INF
01/01/2024 SBC
SmartCare HMO Network
SmartCare HMO Platinum $0
01/01/2024 Summary SBC
SmartCare HMO Platinum $0 INF
01/01/2024 SBC
SmartCare HMO Platinum $10
01/01/2024 Summary SBC
SmartCare HMO Platinum $10 INF
01/01/2024 SBC
SmartCare HMO Platinum $20
01/01/2024 Summary SBC
SmartCare HMO Platinum $20 INF
01/01/2024 SBC
SmartCare HMO Platinum $30
01/01/2024 Summary SBC
SmartCare HMO Platinum $30 INF
01/01/2024 SBC
SmartCare HMO Platinum $35
01/01/2024 Summary SBC
SmartCare HMO Platinum $35 INF
01/01/2024 SBC
SmartCare HMO Gold $30
01/01/2024 Summary SBC
SmartCare HMO Gold $30 INF
01/01/2024 SBC
SmartCare HMO Gold $35
01/01/2024 Summary SBC
SmartCare HMO Gold $35 INF
01/01/2024 SBC
SmartCare HMO Gold $40
01/01/2024 Summary SBC
SmartCare HMO Gold $40 INF
01/01/2024 SBC
SmartCare HMO Gold $50
01/01/2024 Summary SBC
SmartCare HMO Gold $50 INF
01/01/2024 SBC
SmartCare HMO Gold $55
01/01/2024 Summary SBC
SmartCare HMO Gold $55 INF
01/01/2024 SBC
SmartCare HMO Silver $55
01/01/2024 Summary SBC
SmartCare HMO Silver $55 INF
01/01/2024 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $0
01/01/2024 Summary SBC
Salud HMO y Mas Platinum $0 INF
01/01/2024 SBC
Salud HMO y Mas Platinum $10
01/01/2024 Summary SBC
Salud HMO y Mas Platinum $10 INF
01/01/2024 SBC
Salud HMO y Mas Platinum $20
01/01/2024 Summary SBC
Salud HMO y Mas Platinum $20 INF
01/01/2024 SBC
Salud HMO y Mas Platinum $30
01/01/2024 Summary SBC
Salud HMO y Mas Platinum $30 INF
01/01/2024 SBC
Salud HMO y Mas Platinum $35
01/01/2024 Summary SBC
Salud HMO y Mas Platinum $35 INF
01/01/2024 SBC
Salud HMO y Mas Gold $30
01/01/2024 Summary SBC
Salud HMO y Mas Gold $30 INF
01/01/2024 SBC
Salud HMO y Mas Gold $35
01/01/2024 Summary SBC
Salud HMO y Mas Gold $35 INF
01/01/2024 SBC
Salud HMO y Mas Gold $40
01/01/2024 Summary SBC
Salud HMO y Mas Gold $40 INF
01/01/2024 SBC
Salud HMO y Mas Gold $50
01/01/2024 Summary SBC
Salud HMO y Mas Gold $50 INF
01/01/2024 SBC
Salud HMO y Mas Gold $55
01/01/2024 Summary SBC
Salud HMO y Mas Gold $55 INF
01/01/2024 SBC
Salud HMO y Mas Silver $55
01/01/2024 Summary SBC
Salud HMO y Mas Silver $55 INF
01/01/2024 SBC
Salud HMO y Mas SIMNSA
01/01/2024 Summary
CommunityCare HMO Network
CommunityCare HMO Silver $2250/$50
01/01/2024 Summary SBC
CommunityCare HMO Silver $2250/$50 INF
01/01/2024 SBC
CommunityCare HMO Bronze $6300/$60
01/01/2024 Summary SBC
CommunityCare HMO Bronze $6300/$60 INF
01/01/2024 SBC
2024 Medical PPO
Full Network
Platinum PPO 0/15
01/01/2024 Summary SBC
Platinum PPO 0/15 INF
01/01/2024 SBC
Platinum PPO 250/15
01/01/2024 Summary SBC
Platinum PPO 250/15 INF
01/01/2024 SBC
Gold PPO 0/35
01/01/2024 Summary SBC
Gold PPO 0/35 INF
01/01/2024 SBC
Gold PPO 350/25
01/01/2024 Summary SBC
Gold PPO 350/25 INF
01/01/2024 SBC
Gold PPO 500/20
01/01/2024 Summary SBC
Gold PPO 500/20 INF
01/01/2024 SBC
Gold PPO 750/15
01/01/2024 Summary SBC
Gold PPO 750/15 INF
01/01/2024 SBC
Gold PPO 1000/35
01/01/2024 Summary SBC
Gold PPO 1000/35 INF
01/01/2024 SBC
Gold PPO 1600/0
01/01/2024 Summary SBC
Gold PPO 1600/0 INF
01/01/2024 SBC
Gold HDHP PPO 1600/20%
01/01/2024 Summary SBC
Gold HDHP PPO 1600/20% INF
01/01/2024 SBC
Silver PPO 1700/50
01/01/2024 Summary SBC
Silver PPO 1700/50 INF
01/01/2024 SBC
Silver PPO 2250/60
01/01/2024 Summary SBC
Silver PPO 2250/60 INF
01/01/2024 SBC
Silver PPO 2500/55
01/01/2024 Summary SBC
Silver PPO 2500/55 INF
01/01/2024 SBC
Silver HDHP PPO 1600/50%
01/01/2024 Summary SBC
Silver HDHP PPO 1600/50% INF
01/01/2024 SBC
Bronze PPO 6300/60
01/01/2024 Summary SBC
Bronze PPO 6300/60 INF
01/01/2024 SBC
Bronze HDHP PPO 7050/0%
01/01/2024 Summary SBC
Bronze HDHP PPO 7050/0% INF
01/01/2024 SBC
2023 Medical HMO
Full Network HMO
Full Network HMO Platinum $0
01/01/2023 Summary SBC
Full Network HMO Platinum $0 + Infertility
01/01/2023 SBC
Full Network HMO Platinum $10
01/01/2023 Summary SBC
Full Network HMO Platinum $10 + Infertility
01/01/2023 SBC
Full Network HMO Platinum $20
01/01/2023 Summary SBC
Full Network HMO Platinum $20 + Infertility
01/01/2023 SBC
Full Network HMO Platinum $30
01/01/2023 Summary SBC
Full Network HMO Platinum $30 + Infertility
01/01/2023 SBC
Full Network HMO Gold $30
01/01/2023 Summary SBC
Full Network HMO Gold $30 + Infertility
01/01/2023 SBC
Full Network HMO Gold $35
01/01/2023 Summary SBC
Full Network HMO Gold $35 + Infertility
01/01/2023 SBC
Full Network HMO Gold $40
01/01/2023 Summary SBC
Full Network HMO Gold $40 + Infertility
01/01/2023 SBC
Full Network HMO Gold $50
01/01/2023 Summary SBC
Full Network HMO Gold $50 + Infertility
01/01/2023 SBC
Full Network HMO Silver $55
01/01/2023 Summary SBC
Full Network HMO Silver $55 + Infertility
01/01/2023 SBC
WholeCare HMO Network
WholeCare HMO Platinum $0
01/01/2023 Summary SBC
WholeCare HMO Platinum $0 + Infertility
01/01/2023 SBC
WholeCare HMO Platinum $10
01/01/2023 Summary SBC
WholeCare HMO Platinum $10 + Infertility
01/01/2023 SBC
WholeCare HMO Platinum $20
01/01/2023 Summary SBC
WholeCare HMO Platinum $20 + Infertility
01/01/2023 SBC
WholeCare HMO Platinum $30
01/01/2023 Summary SBC
WholeCare HMO Platinum $30 + Infertility
01/01/2023 SBC
WholeCare HMO Gold $30
01/01/2023 Summary SBC
WholeCare HMO Gold $30 + Infertility
01/01/2023 SBC
WholeCare HMO Gold $35
01/01/2023 Summary SBC
WholeCare HMO Gold $35 + Infertility
01/01/2023 SBC
WholeCare HMO Gold $40
01/01/2023 Summary SBC
WholeCare HMO Gold $40 + Infertility
01/01/2023 SBC
WholeCare HMO Gold $50
01/01/2023 Summary SBC
WholeCare HMO Gold $50 + Infertility
01/01/2023 SBC
WholeCare HMO Silver $55
01/01/2023 Summary SBC
WholeCare HMO Silver $55 + Infertility
01/01/2023 SBC
SmartCare HMO Network
SmartCare HMO Platinum $0
01/01/2023 Summary SBC
SmartCare HMO Platinum $0 + Infertility
01/01/2023 SBC
SmartCare HMO Platinum $10
01/01/2023 Summary SBC
SmartCare HMO Platinum $10 + Infertility
01/01/2023 SBC
SmartCare HMO Platinum $20
01/01/2023 Summary SBC
SmartCare HMO Platinum $20 + Infertility
01/01/2023 SBC
SmartCare HMO Platinum $30
01/01/2023 Summary SBC
SmartCare HMO Platinum $30 + Infertility
01/01/2023 SBC
SmartCare HMO Gold $30
01/01/2023 Summary SBC
SmartCare HMO Gold $30 + Infertility
01/01/2023 SBC
SmartCare HMO Gold $35
01/01/2023 Summary SBC
SmartCare HMO Gold $35 + Infertility
01/01/2023 SBC
SmartCare HMO Gold $40
01/01/2023 Summary SBC
SmartCare HMO Gold $40 + Infertility
01/01/2023 SBC
SmartCare HMO Gold $50
01/01/2023 Summary SBC
SmartCare HMO Gold $50 + Infertility
01/01/2023 SBC
SmartCare HMO Silver $55
01/01/2023 Summary SBC
SmartCare HMO Silver $55 + Infertility
01/01/2023 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $0
01/01/2023 Summary SBC
Salud HMO y Mas Platinum $0 + Infertility
01/01/2023 SBC
Salud HMO y Mas Platinum $10
01/01/2023 Summary SBC
Salud HMO y Mas Platinum $10 + Infertility
01/01/2023 SBC
Salud HMO y Mas Platinum $20
01/01/2023 Summary SBC
Salud HMO y Mas Platinum $20 + Infertility
01/01/2023 SBC
Salud HMO y Mas Platinum $30
01/01/2023 Summary SBC
Salud HMO y Mas Platinum $30 + Infertility
01/01/2023 SBC
Salud HMO y Mas Gold $30
01/01/2023 Summary SBC
Salud HMO y Mas Gold $30 + Infertility
01/01/2023 SBC
Salud HMO y Mas Gold $35
01/01/2023 Summary SBC
Salud HMO y Mas Gold $35 + Infertility
01/01/2023 SBC
Salud HMO y Mas Gold $40
01/01/2023 Summary SBC
Salud HMO y Mas Gold $40 + Infertility
01/01/2023 SBC
Salud HMO y Mas Gold $50
01/01/2023 Summary SBC
Salud HMO y Mas Gold $50 + Infertility
01/01/2023 SBC
Salud HMO y Mas Silver $55
01/01/2023 Summary SBC
Salud HMO y Mas Silver $55 + Infertility
01/01/2023 SBC
Salud HMO y Mas SIMNSA
01/01/2023 Summary
CommunityCare HMO Network
CommunityCare HMO Silver $2250/$50
01/01/2023 Summary SBC
CommunityCare HMO Silver $2250/$50 + Infertility
01/01/2023 SBC
CommunityCare HMO Bronze $6300/$65
01/01/2023 Summary SBC
CommunityCare HMO Bronze $6300/$65 + Infertility
01/01/2023 SBC
2023 Medical PPO
Full Network
Platinum PPO 0/15
01/01/2023 Summary SBC
Platinum PPO 0/15 + Infertility
01/01/2023 SBC
Platinum PPO 250/15
01/01/2023 Summary SBC
Platinum PPO 250/15 + Infertility
01/01/2023 SBC
Gold PPO 0/35
01/01/2023 Summary SBC
Gold PPO 0/35 + Infertility
01/01/2023 SBC
Gold PPO 350/25
01/01/2023 Summary SBC
Gold PPO 350/25 + Infertility
01/01/2023 SBC
Gold PPO 500/20
01/01/2023 Summary SBC
Gold PPO 500/20 + Infertility
01/01/2023 SBC
Gold PPO 750/15
01/01/2023 Summary SBC
Gold PPO 750/15 + Infertility
01/01/2023 SBC
Gold PPO 1000/35
01/01/2023 Summary SBC
Gold PPO 1000/35 + Infertility
01/01/2023 SBC
Gold PPO 1600/0
01/01/2023 Summary SBC
Gold PPO 1600/0 + Infertility
01/01/2023 SBC
Silver PPO 1700/50
01/01/2023 Summary SBC
Silver PPO 1700/50 + Infertility
01/01/2023 SBC
Silver PPO 2250/60
01/01/2023 Summary SBC
Silver PPO 2250/60 + Infertility
01/01/2023 SBC
Silver PPO 2500/55
01/01/2023 Summary SBC
Silver PPO 2500/55 + Infertility
01/01/2023 SBC
Silver HDHP PPO 1500/50%
01/01/2023 Summary SBC
Silver HDHP PPO 1500/50% + Infertility
01/01/2023 SBC
Bronze PPO 6300/65
01/01/2023 Summary SBC
Bronze PPO 6300/65 + Infertility
01/01/2023 SBC
Bronze HDHP PPO 7000/0%
01/01/2023 Summary SBC
Bronze HDHP PPO 7000/0% + Infertility
01/01/2023 SBC
Form Name Effective Date Download Form
General Information
2024 Small Group Broker Portfolio Guide
01/01/2024 Download
2024 Small Group Portfolio Desktopper
01/01/2024 Download
2024 SBG Benefit Crosswalk Flyer
01/01/2024 Download
2024 Small Group Ancillary Products Guide
01/01/2024 Download
Ancillary Product Sell Sheet
01/01/2024 Download
Broker Special Commission Schedule 7.23 through 1.24
07/01/2023 Download
Small Group Renewal Guide Q1 2024
01/01/2024 Download
Small Group Renewal Guide Q2 Q3 2023
01/01/2023 Download
HealthNet.com Flyer
02/01/2024 Download
Health Net Beginnings Flyer with Temporary ID Card
11/01/2023 Download
Helpful Information & Resources Flyer
04/01/2024 Download
The HSA for Life Employer Flyer
08/01/2023 Download
Minute Clinic Quick Reference Guide
01/01/2024 Download
Underwriting Simplified Flyer through 9.24
04/01/2024 Download
Enhanced Choice Underwriting Guidelines 1.24
01/01/2024 Download
Dental & Vision Underwriting Guidelines 1.24
01/01/2024 Download
Life Underwriting Guidelines 1.24
01/01/2024 Download
SBG Infertility Benefits GA-Broker Talking Points
02/01/2020 Download
Small Business Savings Brochure - Southern California
01/01/2022 Download
Small Business Savings Brochure - Northern California
01/01/2022 Download
Top 10 Reasons to Sell Health Net
04/01/2022 Download
Top 10 Reasons for Employee Enrollment Delays
01/01/2021 Download
Sharecare Member FAQ
01/01/2024 Download
Unwinding by Sharecare Relaxation on Demand Flyer
06/01/2023 Download
Wellness and Value Added Flyer
02/01/2024 Download
Wellness Online Programs and Support
02/01/2024 Download
2024 Wellness Webinars Schedule
01/01/2024 Download
Medical
Active & Fit Member Flyer
01/01/2024 Download
Behavior Health Benefits Flyer
01/01/2024 Download
Chiropractic Care Flyer
01/01/2024 Download
Cigna Out of State PPO Member FAQ
02/01/2024 Download
Cigna Out of State PPO Transition FAQ
11/01/2023 Download
Cigna Out of State PPO - How to Find a Provider
11/01/2023 Download
Decision Power Healthy Discounts Guide
11/01/2023 Download
Decision Power Health & Wellness Member Guide
11/01/2023 Download
Employee Guide to Health Net Benefits
01/01/2020 Download
ER vs Urgent Care Flyer
01/01/2024 Download
Online Provider Search Instructions
02/01/2024 Download
Generic vs Brand-Name Drugs Information
01/01/2024 Download
Mail Service and Maintenance Choice Pharmacy Program
01/01/2024 Download
CVN Caremark Mail Service Pharmacy Kit
01/01/2024 Download
Pharmacy Benefits Member Guide
02/01/2024 Download
Health Coaching Program
02/01/2024 Download
Health Coaching Member FAQ
02/01/2024 Download
HMO Open Enrollment Flyer
07/01/2022 Download
HSA Compatible PPO Plans Brochure
01/01/2024 Download
CommunityCare Network Brochure
01/01/2023 Download
Small Group HMO Network Guide – Central California 10.23
01/01/2024 Download
Small Group HMO Network Guide – Los Angeles County 10.23
01/01/2024 Download
Small Group HMO Network Guide – Northern California 10.23
01/01/2024 Download
Small Group HMO Network Guide – Orange County 10.23
01/01/2024 Download
Small Group HMO Network Guide – Riverside County 10.23
01/01/2024 Download
Small Group HMO Network Guide – San Bernardino County 10.23
01/01/2024 Download
Small Group HMO Network Guide – San Diego County 10.23
01/01/2024 Download
myStrength Program Flyer
08/01/2023 Download
myStrength Online Mobile Flyer
08/01/2023 Download
Pediatric Dental & Vision (HMO & HSP) Flyer
09/01/2022 Download
Pediatric Dental & Vision (PPO) Flyer
09/01/2022 Download
PPO Fast Facts
07/01/2022 Download
PPO Open Enrollment Flyer
07/01/2022 Download
PPO Open Enrollment Brochure
07/01/2022 Download
Preventive Care Services Overview
02/01/2024 Download
Preventive Screening Guidelines
02/01/2024 Download
Prior Carrier Deductible Credit Flyer
07/01/2022 Download
Scripps & Salud y Mas Flyer
11/01/2021 Download
Salud HMO y Mas Member Brochure-Bilingual
07/01/2021 Download
Salud HMO y Mas Service Area
03/01/2021 Download
Travel Guide - HMO Members
11/01/2023 Download
Travel Guide - PPO Members
11/01/2023 Download
Uniform Glossary of Health Coverage and Medical Terms
07/01/2022 Download
You've got Teladoc Health Flyer
08/01/2023 Download
Teledoc Health Member FAQ
08/01/2023 Download
Dental
Dental Overview Flyer
01/01/2020 Download
Dental Provider Search Instructions
01/01/2023 Download
Vision
Vision Plan Brochure
01/01/2020 Download
Vision Member Website Flyer
01/01/2023 Download
Life
Life and AD&D Product Flyer
07/01/2022 Download
Form Name Effective Date Download Form
SBG Rate Guide - All Rating Areas [effective 4/1/2024]
04/01/2024 Download
SBG Rate Guide - All Rating Areas [effective 1/1/2024]
01/01/2024 Download