Employer Medicare Plan Materials and Forms
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- 2025 Seniority Plus Overview Brochure – English (PDF)
- 2025 Healthy Discounts Brochure – English (PDF)
- 2025 Silver&Fit Flyer – English (PDF)
- 2025 Medicare Step Therapy Part B (PDF)
- 2025 Health Net Medicare Claim Form & Foreign Claim Questionnaire – English (PDF)
- Health Net Provider Search flyer – English (PDF)
- Tag Lines & Nondiscrimination Notice – Multilingual (PDF)
- Notice of Availability – Multilingual (PDF)
- Employer Group Medicare Drug and Pharmacy Information
- Prescription Drug Claim Form – English (PDF) – last updated October 1, 2024
- Prescription Drug Claim Form - En Español (Spanish) (PDF) – last updated October 1, 2024
- Express Scripts Mail Order Form – English (PDF) – last updated October 1, 2024
- Express Scripts Mail Order Form – En Español (Spanish) (PDF) – last updated October 1, 2024
- Covered Diabetes Testing Supplies – English (PDF) – last updated March 1, 2024
- List of Drugs (Formulary) and Change Notices
- Drug Coverage Determination (Exception)
- Drug Redetermination (Appeal) Forms
- Part D Prior Authorization Criteria
- Part D Step Therapy Criteria Forms
- Appointment of Representative Form – English (PDF)
- Appointment of Representative Form – En Español (Spanish) (PDF)
Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directories
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Los Angeles County (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Imperial and San Diego counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Orange County (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Riverside, San Bernadino and Santa Barbara counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Fresno, Kern, Santa Clara, and Tulare counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Alameda, Contra Costa, San Joaquin, and Stanislaus counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – Placer, Sacramento, Solano, and Yolo counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider and Pharmacy Directory – San Francisco, San Mateo, Santa Cruz, and Sonoma counties (PDF)
Health Net Seniority Plus Employer (HMO) Provider Directories
- Health Net Seniority Plus Employer (HMO) Provider Directory – Los Angeles County (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Imperial and San Diego counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Orange County (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Riverside, San Bernadino and Santa Barbara counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Fresno, Kern, Santa Clara, and Tulare counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Alameda, Contra Costa, San Joaquin, and Stanislaus counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – Placer, Sacramento, Solano, and Yolo counties (PDF)
- Health Net Seniority Plus Employer (HMO) Provider Directory – San Francisco, San Mateo, Santa Cruz, and Sonoma counties (PDF)
Medicare Advantage Provider Directories
- Medicare Advantage Dental HMO Provider Directory (PDF)
- Medicare Advantage Vision HMO Provider Directory (PDF)
- Medicare Advantage Chiropractic and Acupuncture Provider Directory (PDF)
- Medicare Advantage Mental Health and Substance Abuse Network Provider Directory (PDF)
- Medicare Advantage Silver&Fit® Provider Directory (PDF)
If you have questions about any of the documents on this page, please contact Member Services. We’re here to help.