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
Large Group Business Application for Group Term Life Insurance Policy
Download
Employer Application - Small Group
Download
Employer Application - Large Group
Download
Employer Change Request Form
12/01/2017 Download
Large Group Electronic Check Form (For New Business Groups)
Download
Large Group Purchaser Claims Data Request Attestation Form
Download
Form Name Effective Date Download Form
Authorization for Disclosure of PHI Form (Spanish)
Download
Authorization for Disclosure of PHI Form
Download
Claim Form - Dental
Download
Claim Form - Life Insurance (Spanish)
Download
Claim Form - Life Insurance
Download
Claim Form - Rx
Download
Claim Form - Vision
Download
Employee Evidence of Insurability Life Form
Download
Employee Group Insurance Conversion Form
Download
Employee Life Insurance Enrollment and Change Form (Spanish)
Download
Employee Life Insurance Enrollment and Change Form
Download
Employee Application - Large Group - Spanish
Download
Employee Application - Large Group
Download
Form Name Effective Date Download Form
Medical HMO
Health Net FullCare HMO Platinum 10
01/01/2017 Summary SBC
Health Net FullCare HMO Platinum 10 INF SBC - 1.17
01/01/2017 SBC
Health Net FullCare HMO Platinum 20
01/01/2017 Summary SBC
Health Net FullCare HMO Platinum 20 INF SBC - 1.17
01/01/2017 SBC
Health Net WholeCare HMO Platinum 10
01/01/2017 Summary SBC
Health Net WholeCare HMO Platinum 10 INF SBC - 1.17
01/01/2017 SBC
Health Net WholeCare HMO Platinum 20
01/01/2017 Summary SBC
Health Net WholeCare HMO Platinum 20 INF SBC - 1.17
01/01/2017 SBC
Health Net SmartCare HMO Platinum 10
01/01/2017 Summary SBC
Health Net SmartCare HMO Platinum 10 INF SBC - 1.17
01/01/2017 SBC
Health Net SmartCare HMO Platinum 20
01/01/2017 Summary SBC
Health Net SmartCare HMO Platinum 20 INF SBC - 1.17
01/01/2017 SBC
Health Net Salud Y Mas HMO Platinum 10
01/01/2017 Summary SBC
Health Net Salud Y Mas HMO Platinum 10 INF SBC - 1.17
01/01/2017 SBC
Health Net Salud Y Mas HMO Platinum 20
01/01/2017 Summary SBC
Health Net Salud Y Mas HMO Platinum 20 INF SBC - 1.17
01/01/2017 SBC
Health Net FullCare HMO Gold 30
01/01/2017 Summary SBC
Health Net FullCare HMO Gold 30 INF SBC - 1.17
01/01/2017 SBC
Health Net FullCare HMO Gold 40
01/01/2017 Summary SBC
Health Net FullCare HMO Gold 40 INF SBC - 1.17
01/01/2017 SBC
Health Net FullCare HMO Gold 50
01/01/2017 Summary SBC
Health Net FullCare HMO Gold 50 INF SBC - 1.17
01/01/2017 SBC
Health Net WholeCare HMO Gold 30
01/01/2017 Summary SBC
Health Net WholeCare HMO Gold 30 INF SBC - 1.17
01/01/2017 SBC
Health Net WholeCare HMO Gold 40
01/01/2017 Summary SBC
Health Net WholeCare HMO Gold 40 INF SBC - 1.17
01/01/2017 SBC
Health Net WholeCare HMO Gold 50
01/01/2017 Summary SBC
Health Net WholeCare HMO Gold 50 INF SBC - 1.17
01/01/2017 SBC
Health Net SmartCare HMO Gold 30
01/01/2017 Summary SBC
Health Net SmartCare HMO Gold 30 SBC INF - 1.17
01/01/2017 SBC
Health Net SmartCare HMO Gold 40
01/01/2017 Summary SBC
Health Net SmartCare HMO Gold 40 INF SBC - 1.17
01/01/2017 SBC
Health Net SmartCare HMO Gold 50
01/01/2017 Summary SBC
Health Net SmartCare HMO Gold 50 INF SBC - 1.17
01/01/2017 SBC
Health Net Salud Y Mas HMO Gold 30
01/01/2017 Summary SBC
Health Net Salud Y Mas HMO Gold 30 INF SBC - 1.17
01/01/2017 SBC
Health Net Salud Y Mas HMO Gold 40
01/01/2017 Summary SBC
Health Net Salud Y Mas HMO Gold 40 INF SBC - 1.17
01/01/2017 SBC
Health Net Salud Y Mas HMO Gold 50
01/01/2017 Summary SBC
Health Net Salud Y Mas HMO Gold 50 INF SBC - 1.17
01/01/2017 SBC
Health Net CommunityCare HMO Gold
01/01/2017 Summary SBC
Health Net CommunityCare HMO Gold INF SBC - 1.17
01/01/2017 SBC
Health Net CommunityCare HMO Silver
01/01/2017 Summary SBC
Health Net CommunityCare HMO Silver 20 INF SBC - 1.17
01/01/2017 SBC
Medical PPO
Health Net PureCare HSP Platinum 90
01/01/2017 Summary SBC
Health Net PureCare HSP Platinum 90 INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Platinum 90
01/01/2017 Summary SBC
Health Net PPO Platinum 90 INF SBC- 1.17
01/01/2017 SBC
Health Net EnhancedCare PPO Gold Value
12/01/2017 Summary
Health Net PureCare HSP Gold 80
01/01/2017 Summary SBC
Health Net PureCare HSP Gold 80 INF SBC - 1.17
01/01/2017 SBC
Health Net PureCare EPO Gold 80 Alt
01/01/2017 Summary SBC
Health Net PureCare EPO Gold 80 Alt INF SBC -1.17
01/01/2017 SBC
Health Net PPO Gold Value
01/01/2017 Summary SBC
Health Net PPO Gold Value INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Gold 80
01/01/2017 Summary SBC
Health Net PPO Gold 80 INF SBC - 1.17
01/01/2017 SBC
Health Net EnhancedCare PPO Silver Value
12/01/2017 Summary
Health Net EnhancedCare PPO Silver HSA
12/01/2017 Summary
Health Net PureCare HSP Silver 70
01/01/2017 Summary SBC
Health Net PureCare HSP Silver 70 INF SBC - 1.17
01/01/2017 SBC
Health Net PureCare EPO Silver 70 Alt
01/01/2017 Summary SBC
Health Net PureCare EPO Silver 70 Alt INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Silver Value
01/01/2017 Summary SBC
Health Net PPO Silver Value INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Silver HSA
12/01/2017 Summary
Health Net PPO Silver 70
01/01/2017 Summary SBC
Health Net PPO Silver 70 INF SBC - 1.17
01/01/2017 SBC
Health Net EnhancedCare PPO Bronze HSA
12/01/2017 Summary
Health Net PureCare HSP Bronze 60
01/01/2017 Summary SBC
Health Net PureCare HSP Bronze 60 INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Bronze HSA
01/01/2017 Summary SBC
Health Net PPO Bronze HSA INF SBC - 1.17
01/01/2017 SBC
Health Net PPO Bronze 60
01/01/2017 Summary SBC
Health Net PPO Bronze 60 INF SBC - 1.17
01/01/2017 SBC
Form Name Effective Date Download Form
Health Net Participation Promo 2017
Download
Health Net Renewal Guide
12/01/2017 Download
Small Group Portfolio
12/01/2017 Download
Enhanced Choice Supplemental
Download
PureCare Wallet Instructions
Download
Form Name Effective Date Download Form