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
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Employer Application - Small Group
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Employer Application - Large Group
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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)
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Authorization for Disclosure of PHI Form
Download
Claim Form - Dental
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Claim Form - Life Insurance (Spanish)
Download
Claim Form - Life Insurance
Download
Claim Form - Rx
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Claim Form - Vision
Download
Employee Evidence of Insurability Life Form
Download
Employee Group Insurance Conversion Form
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Employee Life Insurance Enrollment and Change Form (Spanish)
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Employee Life Insurance Enrollment and Change Form
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Employee Application - Large Group - Spanish
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Employee Application - Large Group
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Form Name Effective Date Download Form
2018 Medical HMO
Full HMO Network
Full Network HMO Platinum $10
01/01/2018 Summary SBC
Full Network HMO Platinum $10 w/Infertility
01/01/2018 SBC
Full Network HMO Platinum $20
01/01/2018 Summary SBC
Full Network HMO Platinum $20 w/Infertility
01/01/2018 SBC
Full Network HMO Platinum $30
07/01/2018 Summary SBC
Full Network HMO Platinum $30 w/Infertility
07/01/2018 SBC
Full Network HMO Gold $30
01/01/2018 Summary SBC
Full Network HMO Gold $30 w/Infertility
01/01/2018 SBC
Full Network HMO Gold $35
07/01/2018 Summary SBC
Full Network HMO Gold $35 w/Infertility
07/01/2018 SBC
Full Network HMO Gold $40
01/01/2018 Summary SBC
Full Network HMO Gold $40 w/Infertility
01/01/2018 SBC
Full Network HMO Silver $40
01/01/2018 Summary SBC
Full Network HMO Silver $40 w/Infertility
01/01/2018 SBC
WholeCare HMO Network
WholeCare HMO Platinum $10
01/01/2018 Summary SBC
WholeCare HMO Platinum $10 w/Infertility
01/01/2018 SBC
WholeCare HMO Platinum $20
01/01/2018 Summary SBC
WholeCare HMO Platinum $20 w/Infertility
01/01/2018 SBC
WholeCare HMO Platinum $30
07/01/2018 Summary SBC
WholeCare HMO Platinum $30 w/Infertility
07/01/2018 SBC
WholeCare HMO Gold $30
01/01/2018 Summary SBC
WholeCare HMO Gold $30 w/Infertility
01/01/2018 SBC
WholeCare HMO Gold $35
07/01/2018 Summary SBC
WholeCare HMO Gold $35 w/Infertility
07/01/2018 SBC
WholeCare HMO Gold $40
01/01/2018 Summary SBC
WholeCare HMO Gold $40 w/Infertility
01/01/2018 SBC
WholeCare HMO Silver $40
01/01/2018 Summary SBC
WholeCare HMO Silver $40 w/Infertility
01/01/2018 SBC
SmartCare HMO Network
SmartCare HMO Platinum $10
01/01/2018 Summary SBC
SmartCare HMO Platinum $10 w/Infertility
01/01/2018 SBC
SmartCare HMO Platinum $20
01/01/2018 Summary SBC
SmartCare HMO Platinum $20 w/Infertility
01/01/2018 SBC
SmartCare HMO Platinum $30
07/01/2018 Summary SBC
SmartCare HMO Platinum $30 w/Infertility
07/01/2018 SBC
SmartCare HMO Gold $30
01/01/2018 Summary SBC
SmartCare HMO Gold $30 w/Infertility
01/01/2018 SBC
SmartCare HMO Gold $35
07/01/2018 Summary SBC
SmartCare HMO Gold $35 w/Infertility
07/01/2018 SBC
SmartCare HMO Gold $40
01/01/2018 Summary SBC
SmartCare HMO Gold $40 w/Infertility
01/01/2018 SBC
SmartCare HMO Silver $40
01/01/2018 Summary SBC
SmartCare HMO Silver $40 w/Infertility
01/01/2018 SBC
CommunityCare HMO Network
CommunityCare HMO Gold $5
01/01/2018 Summary SBC
CommunityCare HMO Gold $5 w/Infertility
01/01/2018 SBC
CommunityCare HMO Silver $20
01/01/2018 Summary SBC
CommunityCare HMO Silver $20 w/Infertility
01/01/2018 SBC
CommunityCare HMO Bronze $45
01/01/2018 Summary SBC
CommunityCare HMO Bronze $45 w/Infertility
01/01/2018 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $10
01/01/2018 Summary SBC
Salud HMO y Mas Platinum $10 w/Infertility
01/01/2018 SBC
Salud HMO y Mas Platinum $20
01/01/2018 Summary SBC
Salud HMO y Mas Platinum $20 w/Infertility
01/01/2018 SBC
Salud HMO y Mas Platinum $30
07/01/2018 Summary SBC
Salud HMO y Mas Platinum $30 w/Infertility
07/01/2018 SBC
Salud HMO y Mas Gold $30
01/01/2018 Summary SBC
Salud HMO y Mas Gold $30 w/Infertility
01/01/2018 SBC
Salud HMO y Mas Gold $35
07/01/2018 Summary SBC
Salud HMO y Mas Gold $35 w/Infertility
07/01/2018 SBC
Salud HMO y Mas Gold $40
01/01/2018 Summary SBC
Salud HMO y Mas Gold $40 w/Infertility
01/01/2018 SBC
Salud HMO y Mas Silver $40
01/01/2018 Summary SBC
Salud HMO y Mas Silver $40 w/Infertility
01/01/2018 SBC
2018 Medical HSP
PureCare Platinum 90 HSP 0/15
01/01/2018 Summary SBC
PureCare Platinum 90 HSP 0/15 w/Infertility
01/01/2018 SBC
PureCare Gold 80 HSP 0/25
01/01/2018 Summary SBC
PureCare Gold 80 HSP 0/25 w/Infertility
01/01/2018 SBC
PureCare Silver 70 HSP 2000/45
01/01/2018 Summary SBC
PureCare Silver 70 HSP 2000/45 w/Infertility
01/01/2018 SBC
PureCare Bronze 60 HSP 6300/75
01/01/2018 Summary SBC
PureCare Bronze 60 HSP 6300/75 w/Infertility
01/01/2018 SBC
2018 Medical PPO
Full PPO Network
Platinum 90 PPO 0/15 + Child Dental
01/01/2018 Summary SBC
Platinum 90 PPO 0/15 + Child Dental w/Infertility
01/01/2018 SBC
Gold 80 PPO 0/25 + Child Dental
01/01/2018 Summary SBC
Gold 80 PPO 0/25 + Child Dental w/Infertility
01/01/2018 SBC
Gold 80 Value PPO 750/10 + Child Dental Alt
01/01/2018 Summary SBC
Gold 80 Value PPO 750/10 + Child Dental Alt w/Infertility
01/01/2018 SBC
Silver 70 PPO 2000/45 + Child Dental
01/01/2018 Summary SBC
Silver 70 PPO 2000/45 + Child Dental w/Infertility
01/01/2018 SBC
Silver 70 Value PPO 1700/30 + Child Dental Alt
01/01/2018 Summary SBC
Silver 70 Value PPO 1700/30 + Child Dental Alt w/Infertility
01/01/2018 SBC
Silver 70 HDHP 1350/40 PPO + Child Dental Alt
01/01/2018 Summary SBC
Silver 70 HDHP 1350/40 PPO + Child Dental Alt w/Infertility
01/01/2018 SBC
Bronze 60 PPO 6300/75 + Child Dental
01/01/2018 Summary SBC
Bronze 60 PPO 6300/75 + Child Dental w/Infertility
01/01/2018 SBC
Bronze 60 HDHP 5600/15 PPO + Child Dental Alt
01/01/2018 Summary SBC
Bronze 60 HDHP 5600/15 PPO + Child Dental Alt w/Infertility
01/01/2018 SBC
EnhancedCare PPO Network
EnhancedCare PPO Gold Value
01/01/2018 Summary SBC
EnhancedCare PPO Gold Value w/Infertility
01/01/2018 SBC
EnhancedCare PPO Silver Value
01/01/2018 Summary SBC
EnhancedCare PPO Silver Value w/Infertility
01/01/2018 SBC
Silver 70 HDHP 1350/40 EnhancedCare PPO + Child Dental Alt
01/01/2018 Summary SBC
Silver 70 HDHP 1350/40 EnhancedCare PPO + Child Dental Alt w/Infertility
01/01/2018 SBC
Bronze 60 HDHP 5600/15 EnhancedCare PPO + Child Dental Alt
01/01/2018 Summary SBC
Bronze 60 HDHP 5600/15 EnhancedCare PPO + Child Dental Alt w/Infertility
01/01/2018 SBC
2017 Medical HMO
Full HMO Network
Full Network HMO Platinum $10
01/01/2017 Summary SBC
Full Network HMO Platinum $10 w/Infertility
01/01/2017 SBC
Full Network HMO Platinum $20
01/01/2017 Summary SBC
Full Network HMO Platinum $20 w/Infertility
01/01/2017 SBC
Full Network HMO Gold $30
01/01/2017 Summary SBC
Full Network HMO Gold $30 w/Infertility
01/01/2017 SBC
Full Network HMO Gold $40
01/01/2017 Summary SBC
Full Network HMO Gold $40 w/Infertility
01/01/2017 SBC
Full Network HMO Gold $50
01/01/2017 Summary SBC
Full Network HMO Gold $50 w/Infertility
01/01/2017 SBC
WholeCare HMO Network
WholeCare HMO Platinum $10
01/01/2017 Summary SBC
WholeCare HMO Platinum $10 w/Infertility
01/01/2017 SBC
WholeCare HMO Platinum $20
01/01/2017 Summary SBC
WholeCare HMO Platinum $20 w/Infertility
01/01/2017 SBC
WholeCare HMO Gold $30
01/01/2017 Summary SBC
WholeCare HMO Gold $30 w/Infertility
01/01/2017 SBC
WholeCare HMO Gold $40
01/01/2017 Summary SBC
WholeCare HMO Gold $40 w/Infertility
01/01/2017 SBC
WholeCare HMO Gold $50
01/01/2017 Summary SBC
WholeCare HMO Gold $50 w/Infertility
01/01/2017 SBC
SmartCare HMO Network
SmartCare HMO Platinum $10
01/01/2017 Summary SBC
SmartCare HMO Platinum $10 w/Infertility
01/01/2017 SBC
SmartCare HMO Platinum $20
01/01/2017 Summary SBC
SmartCare HMO Platinum $20 w/Infertility
01/01/2017 SBC
SmartCare HMO Gold $30
01/01/2017 Summary SBC
SmartCare HMO Gold $30 w/Infertility
01/01/2017 SBC
SmartCare HMO Gold $40
01/01/2017 Summary SBC
SmartCare HMO Gold $40 w/Infertility
01/01/2017 SBC
SmartCare HMO Gold $50
01/01/2017 Summary SBC
SmartCare HMO Gold $50 w/Infertility
01/01/2017 SBC
CommunityCare HMO Network
CommunityCare HMO Gold $5
01/01/2017 Summary SBC
CommunityCare HMO Gold $5 w/Infertility
01/01/2017 SBC
CommunityCare HMO Silver $20
01/01/2017 Summary SBC
CommunityCare HMO Silver $20 w/Infertility
01/01/2017 SBC
Salud y Mas HMO Network
Salud HMO y Mas Platinum $10
01/01/2017 Summary SBC
Salud HMO y Mas Platinum $10 w/Infertility
01/01/2017 SBC
Salud HMO y Mas Platinum $20
01/01/2017 Summary SBC
Salud HMO y Mas Platinum $20 w/Infertility
01/01/2017 SBC
Salud HMO y Mas Gold $30
01/01/2017 Summary SBC
Salud HMO y Mas Gold $30 w/Infertility
01/01/2017 SBC
Salud HMO y Mas Gold $40
01/01/2017 Summary SBC
Salud HMO y Mas Gold $40 w/Infertility
01/01/2017 SBC
Salud HMO y Mas Gold $50
01/01/2017 Summary SBC
Salud HMO y Mas Gold $50 w/Infertility
01/01/2017 SBC
2017 Medical HSP
PureCare Platinum 90 HSP 0/15
01/01/2017 Summary SBC
PureCare Platinum 90 HSP 0/15 w/Infertility
01/01/2017 SBC
PureCare Gold 80 HSP 0/30
01/01/2017 Summary SBC
PureCare Gold 80 HSP 0/30 w/Infertility
01/01/2017 SBC
PureCare Silver 70 HSP 2000/45
01/01/2017 Summary SBC
PureCare Silver 70 HSP 2000/45 w/Infertility
01/01/2017 SBC
PureCare Bronze 60 HSP 6300/75
01/01/2017 Summary SBC
PureCare Bronze 60 HSP 6300/75 w/Infertility
01/01/2017 SBC
2017 Medical EPO
PureCare Gold 80 EPO 1300/20 Alternate
01/01/2017 Summary SBC
PureCare Gold 80 EPO 1300/20 Alternate w/Infertility
01/01/2017 SBC
PureCare Silver 70 EPO 2000/20 Alternate
01/01/2017 Summary SBC
PureCare Silver 70 EPO 2000/20 Alternate w/Infertility
01/01/2017 SBC
2017 Medical PPO
Full PPO Network
Platinum 90 PPO 0/15
01/01/2017 Summary SBC
Platinum 90 PPO 0/15 w/Infertility
01/01/2017 SBC
Gold 80 PPO 0/30
01/01/2017 Summary SBC
Gold 80 PPO 0/30 w/Infertility
01/01/2017 SBC
PPO Gold 80 Value
01/01/2017 Summary SBC
PPO Gold 80 Value w/Infertility
01/01/2017 SBC
Silver 70 PPO 2000/45
01/01/2017 Summary SBC
Silver 70 PPO 2000/45 w/Infertility
01/01/2017 SBC
PPO Silver 70 Value
01/01/2017 Summary SBC
PPO Silver 70 Value w/Infertility
01/01/2017 SBC
PPO Silver HSA
12/01/2017 Summary SBC
PPO Silver HSA w/Infertility
12/01/2017 SBC
Bronze 60 PPO 6300/75
01/01/2017 Summary SBC
Bronze 60 PPO 6300/75 w/Infertility
01/01/2017 SBC
PPO Bronze HSA
01/01/2017 Summary SBC
PPO Bronze HSA w/Infertility
01/01/2017 SBC
EnhancedCare PPO Network
EnhancedCare PPO Gold Value
12/01/2017 Summary SBC
EnhancedCare PPO Gold Value w/Infertility
12/01/2017 SBC
EnhancedCare PPO Silver Value
12/01/2017 Summary SBC
EnhancedCare PPO Silver Value w/Infertility
12/01/2017 SBC
EnhancedCare PPO Silver HSA
12/01/2017 Summary SBC
EnhancedCare PPO Silver HSA w/Infertility
12/01/2017 SBC
EnhancedCare PPO Bronze HSA
12/01/2017 Summary SBC
EnhancedCare PPO Bronze HSA w/Infertility
12/01/2017 SBC
Form Name Effective Date Download Form
Provider Search Instructions
01/01/2018 Download
Health Net Small Group Portfolio Desktopper for 2018
01/01/2018 Download
More Ways to Satisfy in Q2
04/01/2018 Download
Health Net Network Comparison List - San Diego County
02/01/2018 Download
Decision Power Health Discounts Flyer
01/01/2018 Download
Health Net Renewal Guide
12/01/2017 Download
Enhanced Choice Supplemental
Download
PureCare Wallet Instructions
Download
Form Name Effective Date Download Form