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 1.22
01/01/2022 Download
Employer Application 1.23
01/01/2023 Download
Electronic Check Form
05/01/2022 Download
Group Size Attestation Form
07/01/2022 Download
Proof of Eligibility Statement for Sole Proprietor, Partner or Corporate Officer
01/01/2022 Download
Religious Organization Exemption Form
07/01/2022 Download
In Force Group Forms
Employer Group Size Attestation Form
07/01/2022 Download
Renewal Plan Election & Open Enrollment Change Form 1.22
01/01/2022 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
07/01/2022 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 1.22
01/01/2022 Download
Employee Enrollment/Change Form 1.23
01/01/2023 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 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
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
2022 Medical HMO
Full Network HMO
Full Network HMO Platinum $0
01/01/2022 Summary SBC
Full Network HMO Platinum $0 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Platinum $10
01/01/2022 Summary SBC
Full Network HMO Platinum $10 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Platinum $20
01/01/2022 Summary SBC
Full Network HMO Platinum $20 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Platinum $30
01/01/2022 Summary SBC
Full Network HMO Platinum $30 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Gold $30
01/01/2022 Summary SBC
Full Network HMO Gold $30 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Gold $35
01/01/2022 Summary SBC
Full Network HMO Gold $35 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Gold $40
01/01/2022 Summary SBC
Full Network HMO Gold $40 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Gold $50
01/01/2022 Summary SBC
Full Network HMO Gold $50 INF (with Infertility)
01/01/2022 SBC
Full Network HMO Silver $50
01/01/2022 Summary SBC
Full Network HMO Silver $50 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Network
WholeCare HMO Platinum $0
01/01/2022 Summary SBC
WholeCare HMO Platinum $0 +INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Platinum $10
01/01/2022 Summary SBC
WholeCare HMO Platinum $10 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Platinum $20
01/01/2022 Summary SBC
WholeCare HMO Platinum $20 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Platinum $30
01/01/2022 Summary SBC
WholeCare HMO Platinum $30 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Gold $30
01/01/2022 Summary SBC
WholeCare HMO Gold $30 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Gold $35
01/01/2022 Summary SBC
WholeCare HMO Gold $35 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Gold $40
01/01/2022 Summary SBC
WholeCare HMO Gold $40 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Gold $50
01/01/2022 Summary SBC
WholeCare HMO Gold $50 INF (with Infertility)
01/01/2022 SBC
WholeCare HMO Silver $50
01/01/2022 Summary SBC
WholeCare HMO Silver $50 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Network
SmartCare HMO Platinum $0
01/01/2022 Summary SBC
SmartCare HMO Platinum $0 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Platinum $10
01/01/2022 Summary SBC
SmartCare HMO Platinum $10 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Platinum $20
01/01/2022 Summary SBC
SmartCare HMO Platinum $20 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Platinum $30
01/01/2022 Summary SBC
SmartCare HMO Platinum $30 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Gold $30
01/01/2022 Summary SBC
SmartCare HMO Gold $30 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Gold $35
01/01/2022 Summary SBC
SmartCare HMO Gold $35 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Gold $40
01/01/2022 Summary SBC
SmartCare HMO Gold $40 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Gold $50
01/01/2022 Summary SBC
SmartCare HMO Gold $50 INF (with Infertility)
01/01/2022 SBC
SmartCare HMO Silver $50
01/01/2022 Summary SBC
SmartCare HMO Silver $50 INF (with Infertility)
01/01/2022 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $0
01/01/2022 Summary SBC
Salud HMO y Mas Platinum $0 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Platinum $10
01/01/2022 Summary SBC
Salud HMO y Mas Platinum $10 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Platinum $20
01/01/2022 Summary SBC
Salud HMO y Mas Platinum $20 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Platinum $30
01/01/2022 Summary SBC
Salud HMO y Mas Platinum $30 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Gold $30
01/01/2022 Summary SBC
Salud HMO y Mas Gold $30 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Gold $35
01/01/2022 Summary SBC
Salud HMO y Mas Gold $35 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Gold $40
01/01/2022 Summary SBC
Salud HMO y Mas Gold $40 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Gold $50
01/01/2022 Summary SBC
Salud HMO y Mas Gold $50 INF (with Infertility)
01/01/2022 SBC
Salud HMO y Mas Silver $50
01/01/2022 Summary SBC
Salud HMO y Mas Silver $50 INF (with Infertility)
01/01/2022 SBC
CommunityCare HMO Network
CommunityCare HMO Silver $1750/$50
01/01/2022 Summary SBC
CommunityCare HMO Silver $1750/$50 INF (with Infertility)
01/01/2022 SBC
Health Net CommunityCare Bronze 60 HMO 6300/65 + Child Dental
01/01/2022 Summary SBC
Health Net CommunityCare Bronze 60 HMO 6300/65 + Child Dental INF (with Infertility)
01/01/2022 SBC
2022 Medical HSP
Health Net PureCare Platinum 90 HSP 0/15 + Child Dental
01/01/2022 Summary SBC
Health Net PureCare Platinum 90 HSP 0/15 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net PureCare Gold 80 HSP 350/25 + Child Dental
01/01/2022 Summary SBC
Health Net PureCare Gold 80 HSP 350/25 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net PureCare Silver 70 HSP 2250/50 + Child Dental
01/01/2022 Summary SBC
Health Net PureCare Silver 70 HSP 2250/50 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental
01/01/2022 Summary SBC
Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental INF (with Infertility)
01/01/2022 SBC
2022 Medical PPO
Full Network
Health Net Platinum 90 PPO 0/15 + Child Dental
01/01/2022 Summary SBC
Health Net Platinum 90 PPO 0/15 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net Platinum 90 PPO 250/15 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Platinum 90 PPO 250/15 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 PPO 0/30 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Gold 80 PPO 0/30 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 PPO 350/25 + Child Dental
01/01/2022 Summary SBC
Health Net Gold 80 PPO 350/25 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 PPO 500/20 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Gold 80 PPO 500/20 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 Value PPO 750/15 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Gold 80 Value PPO 750/15 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 PPO 1000/30 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Gold 80 PPO 1000/30 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Gold 80 PPO 1500/0 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Gold 80 PPO 1500/0 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Silver 70 PPO 2250/50 + Child Dental
01/01/2022 Summary SBC
Health Net Silver 70 PPO 2250/50 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net Silver 70 PPO 2250/55 + Child Dental Alt
01/01/2022 Summary SBC
Health Net Silver 70 PPO 2250/55 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt
01/01/2022 Summary SBC
Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net Bronze 60 PPO 6300/65 + Child Dental
01/01/2022 Summary SBC
Health Net Bronze 60 PPO 6300/65 + Child Dental INF (with Infertility)
01/01/2022 SBC
Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental
01/01/2022 Summary SBC
Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental INF (with Infertility)
01/01/2022 SBC
EnhancedCare PPO Network
Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt
01/01/2022 Summary SBC
Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF (with Infertility)
01/01/2022 SBC
2021 Medical HMO
Full HMO Network
Full Network HMO Platinum $0
01/01/2021 Summary SBC
Full Network HMO Platinum $0 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Platinum $10
01/01/2021 Summary SBC
Full Network HMO Platinum $10 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Platinum $20
01/01/2021 Summary SBC
Full Network HMO Platinum $20 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Platinum $30
01/01/2021 Summary SBC
Full Network HMO Platinum $30 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Gold $30
01/01/2021 Summary SBC
Full Network HMO Gold $30 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Gold $35
01/01/2021 Summary SBC
Full Network HMO Gold $35 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Gold $40
01/01/2021 Summary SBC
Full Network HMO Gold $40 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Gold $50
01/01/2021 Summary SBC
Full Network HMO Gold $50 INF (with Infertility)
01/01/2021 SBC
Full Network HMO Silver $50
01/01/2021 Summary SBC
Full Network HMO Silver $50 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Network
WholeCare HMO Platinum $0
01/01/2021 Summary SBC
WholeCare HMO Platinum $0 +INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Platinum $10
01/01/2021 Summary SBC
WholeCare HMO Platinum $10 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Platinum $20
01/01/2021 Summary SBC
WholeCare HMO Platinum $20 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Platinum $30
01/01/2021 Summary SBC
WholeCare HMO Platinum $30 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Gold $30
01/01/2021 Summary SBC
WholeCare HMO Gold $30 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Gold $35
01/01/2021 Summary SBC
WholeCare HMO Gold $35 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Gold $40
01/01/2021 Summary SBC
WholeCare HMO Gold $40 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Gold $50
01/01/2021 Summary SBC
WholeCare HMO Gold $50 INF (with Infertility)
01/01/2021 SBC
WholeCare HMO Silver $50
01/01/2021 Summary SBC
WholeCare HMO Silver $50 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Network
SmartCare HMO Platinum $0
01/01/2021 Summary SBC
SmartCare HMO Platinum $0 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Platinum $10
01/01/2021 Summary SBC
SmartCare HMO Platinum $10 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Platinum $20
01/01/2021 Summary SBC
SmartCare HMO Platinum $20 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Platinum $30
01/01/2021 Summary SBC
SmartCare HMO Platinum $30 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Gold $30
01/01/2021 Summary SBC
SmartCare HMO Gold $30 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Gold $35
01/01/2021 Summary SBC
SmartCare HMO Gold $35 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Gold $40
01/01/2021 Summary SBC
SmartCare HMO Gold $40 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Gold $50
01/01/2021 Summary SBC
SmartCare HMO Gold $50 INF (with Infertility)
01/01/2021 SBC
SmartCare HMO Silver $50
01/01/2021 Summary SBC
SmartCare HMO Silver $50 INF (with Infertility)
01/01/2021 SBC
CommunityCare HMO Network
CommunityCare HMO Silver $1750/$50
01/01/2021 Summary SBC
CommunityCare HMO Silver $1750/$50 INF (with Infertility)
01/01/2021 SBC
Health Net CommunityCare Bronze 60 HMO 6300/65 + Child Dental
01/01/2021 Summary SBC
Health Net CommunityCare Bronze 60 HMO 6300/65 + Child Dental INF (with Infertility)
01/01/2021 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $0
01/01/2021 Summary SBC
Salud HMO y Mas Platinum $0 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Platinum $10
01/01/2021 Summary SBC
Salud HMO y Mas Platinum $10 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Platinum $20
01/01/2021 Summary SBC
Salud HMO y Mas Platinum $20 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Platinum $30
01/01/2021 Summary SBC
Salud HMO y Mas Platinum $30 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Gold $30
01/01/2021 Summary SBC
Salud HMO y Mas Gold $30 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Gold $35
01/01/2021 Summary SBC
Salud HMO y Mas Gold $35 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Gold $40
01/01/2021 Summary SBC
Salud HMO y Mas Gold $40 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Gold $50
01/01/2021 Summary SBC
Salud HMO y Mas Gold $50 INF (with Infertility)
01/01/2021 SBC
Salud HMO y Mas Silver $50
01/01/2021 Summary SBC
Salud HMO y Mas Silver $50 INF (with Infertility)
01/01/2021 SBC
2021 Medical HSP
Health Net PureCare Platinum 90 HSP 0/15 + Child Dental
01/01/2021 Summary SBC
Health Net PureCare Platinum 90 HSP 0/15 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net PureCare Gold 80 HSP 350/25 + Child Dental
01/01/2021 Summary SBC
Health Net PureCare Gold 80 HSP 350/25 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net PureCare Silver 70 HSP 2250/50 + Child Dental
01/01/2021 Summary SBC
Health Net PureCare Silver 70 HSP 2250/50 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental
01/01/2021 Summary SBC
Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental INF (with Infertility)
01/01/2021 SBC
2021 Medical PPO
Full PPO Network
Health Net Platinum 90 PPO 0/15 + Child Dental
01/01/2021 Summary SBC
Health Net Platinum 90 PPO 0/15 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net Platinum 90 PPO 250/15 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Platinum 90 PPO 250/15 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 PPO 0/30 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Gold 80 PPO 0/30 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 PPO 350/25 + Child Dental
01/01/2021 Summary SBC
Health Net Gold 80 PPO 350/25 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 PPO 500/20 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Gold 80 PPO 500/20 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 Value PPO 750/15 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Gold 80 Value PPO 750/15 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 PPO 1000/30 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Gold 80 PPO 1000/30 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Gold 80 PPO 1500/0 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Gold 80 PPO 1500/0 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Silver 70 PPO 2250/50 + Child Dental
01/01/2021 Summary SBC
Health Net Silver 70 PPO 2250/50 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net Silver 70 PPO 2250/55 + Child Dental Alt
01/01/2021 Summary SBC
Health Net Silver 70 PPO 2250/55 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt
01/01/2021 Summary SBC
Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net Bronze 60 PPO 6300/65 + Child Dental
01/01/2021 Summary SBC
Health Net Bronze 60 PPO 6300/65 + Child Dental INF (with Infertility)
01/01/2021 SBC
Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental
01/01/2021 Summary SBC
Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental INF (with Infertility)
01/01/2021 SBC
EnhancedCare PPO Network
Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt
01/01/2021 Summary SBC
Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF (with Infertility)
01/01/2021 SBC
Form Name Effective Date Download Form
General Information
2022 Small Group Broker Portfolio Guide
01/01/2022 Download
2022 Small Group Portfolio Desktopper
01/01/2022 Download
2022 Small Group Ancillary Products Guide
01/01/2022 Download
Ancillary Product Sell Sheet 1.22
01/01/2022 Download
2023 Small Group Broker Portfolio Guide
01/01/2023 Download
2023 Small Group Portfolio Desktopper
01/01/2023 Download
2023 Small Group Ancillary Products Guide
01/01/2023 Download
Ancillary Product Sell Sheet 1.23
01/01/2023 Download
Small Group Renewal Guide Q4 2022
10/01/2022 Download
Small Group Renewal Guide Q1 2023
01/01/2023 Download
HealthNet.com Flyer
08/01/2022 Download
Helpful Information & Resources Flyer
01/01/2022 Download
The HSA for Life Employer Flyer
07/01/2022 Download
Minute Clinic Listing
07/01/2022 Download
Online Provider Search Instructions
07/01/2022 Download
Underwriting Simplified Flyer through December 2022
08/01/2022 Download
Enhanced Choice A Underwriting Guidelines 3.22
03/01/2022 Download
Enhanced Choice B Underwriting Guidelines 3.22
03/01/2022 Download
Dental & Vision Underwriting Guidelines 3.22
03/01/2022 Download
Life Underwriting Guidelines 3.22
03/01/2022 Download
Underwriting Simplified Flyer through March 2023
01/01/2023 Download
Enhanced Choice Underwriting Guidelines 1.23
01/01/2023 Download
Dental & Vision Underwriting Guidelines 1.23
01/01/2023 Download
Life Underwriting Guidelines 1.23
01/01/2023 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
2022 Free Wellness Webinars Flyer
07/01/2022 Download
Medical
Active & Fit Member Flyer
01/01/2022 Download
Babylon Health Flyer
01/01/2022 Download
Behavior Health Benefits with MHN Services Flyer
04/01/2022 Download
Beginnings Open Enrollment Flyer
07/01/2022 Download
California MinuteClinic Health Reference Guide
01/01/2022 Download
Decision Power Healthy Discounts Guide
01/01/2022 Download
Decision Power Health & Wellness Member Guide
01/01/2022 Download
Employee Guide to Health Net Benefits
01/01/2020 Download
ER vs Urgent Care Flyer
07/01/2022 Download
First Health Network Out of State FAQ for Brokers
07/01/2022 Download
First Health Network Out of State FAQ for Members
07/01/2022 Download
Generic vs Brand-Name Drugs Information
07/01/2022 Download
Getting Started with Mail Order Pharmacy Kit
07/01/2022 Download
Maintenance Choice Pharmacy Program
09/01/2022 Download
Advanced Choice Pharmacy Network [used for CommunityCare, Salud y Mas, SmartCare HMO plans and EnhancedCare PPO plans]
01/01/2020 Download
Standard Pharmacy Network
01/01/2020 Download
Health Coaching Program
07/01/2022 Download
CommunityCare Network Guide
01/01/2022 Download
Small Group HMO Network Guide – Central California
03/01/2022 Download
Small Group HMO Network Guide – Los Angeles County
03/01/2022 Download
Small Group HMO Network Guide – Northern California
03/01/2022 Download
Small Group HMO Network Guide – Orange County
03/01/2022 Download
Small Group HMO Network Guide – Riverside County
03/01/2022 Download
Small Group HMO Network Guide – San Bernardino County
03/01/2022 Download
Small Group HMO Network Guide – San Diego County
03/01/2022 Download
HMO Open Enrollment Flyer
07/01/2022 Download
HSA Compatible PPO Plans Brochure
07/01/2022 Download
myStrength Program Flyer
07/01/2022 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 Guide
07/01/2022 Download
Preventive Screening Guidelines
07/01/2022 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
Text4Baby Flyer
01/01/2020 Download
Travel Guide - HMO & POS Members
07/01/2022 Download
Travel Guide - PPO Members
07/01/2022 Download
Uniform Glossary of Health Coverage and Medical Terms
07/01/2022 Download
Wellness Rewards Program
01/01/2022 Download
Dental
Dental Overview Flyer
01/01/2020 Download
Dental Member Website Flyer
01/01/2020 Download
Dental Provider Search Instructions
01/01/2020 Download
Vision
Vision Plan Brochure
01/01/2020 Download
Vision Member Website Flyer
01/01/2020 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 10/1/2022]
10/01/2022 Download
SBG Rate Guide - All Rating Areas [effective 1/1/2023]
01/01/2023 Download