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Forms & Brochures – Small Business Group Plans

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To view or download a file, click the desired language link. The PDF file will open in a new window or tab of your browser. From there, you can also download or print the file.

CommunityCare HMO

Full Network HMO

Salud HMO y Más

SmartCare HMO

WholeCare HMO

CommunityCare HMO

Full Network HMO

SmartCare HMO

WholeCare HMO

Salud HMO y Más

Ancillary Add-On or Change Form

Ancillary Add-On or Change Form – English (PDF)

Enrollment and Change Applications

Employee Enrollment and Change Form (2024)

Employee Enrollment and Change Form (2023)

Renewal Election and Open Enrollment Medical Plan Change Request Form

Must be completed & signed by the Employer Group.

Application for Group Service Agreement/Policy

Must be completed & signed by the Employer Group and Broker at time of enrollment and submitted along with check for first month's premium and enrollment forms. For renewals, this form must be completed and signed by the Employer Group and submitted to SBG Account Management for processing.

Religious Exemption Employer Form

Religious Exemption Employer Form – English (PDF)

Transition of Care

Claims

HIPAA Disclosures

Health Net Life Insurance Forms

Additional Forms

New to Health Net? Contact Health Net Account Management, 1-800-447-8812, option 2, for questions on standard benefit rates.

Looking for CalChoice or Covered California Small Business rates? Visit the CalChoice website, or contact Covered California Small Business at 1-877-752-4737.

Standard

2024

2023

2022

Sales Support Tools and Broker Materials

CommunityCare

Care Access

National PPO Network (Out-of-State PPO)

Additional Member/Prospect Materials

Behavioral Health

Employer Materials

Glossaries

Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hardcopy of the document by mail.

Travel Guides

Members can download claim forms at Health Net. Claim forms can also be found under the Applications and Forms section on this page.

Members can download claim forms at Health Net. Claim forms can also be found under the Applications and Forms section on this page.

Additional Materials

Covered California Collateral

Get fact sheets and collateral

Last Updated: 02/20/2024