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Forms & Brochures – Large Business Group Plans

How to View/Download Files

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.

Presentation Folders

Open Enrollment Product flyers

To be used as inserts with the OE Folders, may not be used as stand-alone flyers.

2021 – Enrollment and Change Applications

2020 – Enrollment and Change Applications

Group Service Agreement/Policy Applications

Claims

Transition of Care

Dental and Vision Add-On or Change Form

Dental and Vision Add-On or Change Form (PDF)

Health Net Life Insurance Forms

Broker and Employer Forms

HIPAA Disclosures

Health Care Reform Materials

SmartCare

Support Tools

Available through your PPO insurance plan and the SELECT/ELECT 2 (PPO) tier of your SELECT (POS) or Elect Open Access health plan.

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.

Health Net Beginnings

Online Support Tools

First Health National (Out-of-State) PPO

Are your clients looking for greater convenience, service and choice in consumer directed health care benefits? We have partnered with HealthEquity for HRA and HSA integration alongside our Large group products. A proven expert in financial arrangement integration and administration, HealthEquity offers easy-to-use tools and comprehensive resources. Our PPO high deductible health plans (HDHP's), can be offered alongside their integrated health savings account (HSA), while all of our PPO plans can be offered with their integrated health reimbursement account (HRA).

Learn more about HealthEquity HSA & HRA Plans on the HealthEquity website. Go to HealthEquity sales resource site.

Full Network HMO

ExcelCare HMO

SmartCare HMO

Salud HMO y Más / Salud San Diego

Salud HMO y Más – Facility Deductible

Salud Mexico

New for 2021! – CanopyCare HMO

POS-Elect Open Access (EOA)

POS-Elect Open Access (EOA) – Facility Deductible

ExcelCare EOA

ExcelCare EOA - Facility Deductible

PPO

PPO (HSA-compatible) (Includes pre-set pharmacy plans)

Pharmacy HMO

(combined medical and pharmacy OOPM)

Pharmacy POS – Elect Open Access (EOA)/ExcelCare EOA

(combined medical and pharmacy OOPM)

Pharmacy HMO – Salud HMO y Más

(combined medical and pharmacy OOPM)

New for 2021! – CanopyCare HMO

(combined medical and pharmacy OOPM)

Pharmacy PPO

(combined medical and pharmacy OOPM)

Pharmacy PPO- HSA compatible

(combined medical and pharmacy OOPM)

Chiropractic / Acupuncture

Chiropractic Care

Chiropractic Care – HMO/EOA – English (PDF)

Dental – HMO

Dental – PPO

Vision Plans

HMO

(combined medical and pharmacy OOPM)

POS-Elect Open Access (EOA)

(combined medical and pharmacy OOPM)

POS-Elect Open Access (EOA) – Facility Deductible

(combined medical and pharmacy OOPM)

SmartCare HMO

(combined medical and pharmacy OOPM)

Salud HMO y Mas

(combined medical and pharmacy OOPM)

Salud Mexico

PPO

(combined medical and pharmacy OOPM)

PPO HSA-Compatible

Pharmacy HMO

(combined medical and pharmacy OOPM)

Pharmacy POS- Elect Open Access (EOA)/ExcelCare EOA

(combined medical and pharmacy OOPM)

Pharmacy HMO – Salud HMO y Mas

(combined medical and pharmacy OOPM)

Pharmacy PPO

(combined medical and pharmacy OOPM)

Pharmacy PPO – HSA compatible

(combined medical and pharmacy OOPM)

Chiropractic / Acupuncture

Chiropractic Care

Chiropractic Care – HMO/EOA – English (PDF)

Dental – HMO

Dental – PPO

Vision Plans

Covered California Collateral

Get fact sheets and collateral here

Last Updated: 06/21/2021