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Member FAQs

Your Most Frequently Asked Questions

We're here to answer any questions you have about your Health Net plan. If you have a question or concern that is not addressed here, please contact us. Many of your questions can be answered when you log in to your account online.

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Doctor and Provider Network Answers

back to FAQ listHow do I find out which providers (doctors, hospitals, etc.) are in my network?

  1. Log in to your member account with your user name and password.
  2. Click on the ProviderSearch link.
  3. Your region and plan information will already appear.
  4. Narrow your search further by selecting type of provider, including:

    • doctors,
    • urgent care and walk-in clinics,
    • hospitals,
    • medical groups,
    • other facilities, and
    • ancillary services.

Medicare Supplement members:
You may seek care for covered benefits from any provider that accepts Medicare.

back to FAQ listAm I covered if I seek medical care outside the network?

– HMO, EPO and Health service plan (HSP) members:
You are only covered for health care services you get from inside the provider network.

In a medical emergency, go straight to the nearest hospital – It does not have to be in your plan's provider network. If you are admitted to a hospital because of an injury or life-threatening medical emergency, you (or someone acting for you) should notify your PCP as soon as reasonably possible.

– PPO members:
With a PPO, you have the option of getting services "in" or "out" of your plan's network. Going outside of your plan's network may cost you more.

– Medicare Advantage members:
In most HMO plans, members can only go to doctors, other health care providers or hospitals in the plan's network, except for:

  • emergency care,
  • out-of-area urgent care, or
  • out-of-area dialysis.

If you get routine care from out-of-network providers, neither Medicare nor Health Net will pay for the costs.

In a PPO plan, you can use doctors, hospitals and other health care providers that belong to your plan's network, or you can get care from an out-of-network Medicare provider. It may cost you more to go out-of-network.

Your Coverage Document will provide detailed information regarding your plan benefits. To view your Coverage Document on www.healthnet.com, you must be registered with our website.

If you can't find this information, please Contact us. We're happy to help!

back to FAQ listIf I've been assigned to a primary care physician (PCP) or medical group, how do I find this information?

You can view this information in one of two ways:

  • It will appear on your Health Net member ID card.
  • This information is also available on the Member site.

In order to view this information, you must be registered on our website, www.healthnet.com. Once you are logged in, your physician/medical group information is viewable on the main page.

Please note: Not all plans require an assigned PCP or medical group.

back to FAQ listHow do I find the PCP or medical group for my spouse or dependents on my plan?

  1. Log in to your member account with your user name and password.
  2. You will see your member information. If you have access to other members on the policy, you can select their names from the drop-down list called "Viewing information for". The page will refresh with information for the member you selected.

back to FAQ listHow do I change my PCP for my HMO or HSP plan?

Here are some simple steps to take if you want to change your PCP:

  1. Log in to your member account with your user name and password.
  2. Go to ProviderSearch and select a new doctor, then click on View Details.
  3. Next, click on SET AS PCP.

You can also change your PCP from your member home page. You'll need your new doctor's ID number. After logging in to your member account:

  1. Go to our member home page,
  2. Click the pencil icon that appears next to MY DOCTOR information, then
  3. Enter your new doctor's ID number.

back to FAQ listHow do I find out which hospital(s) my medical group is affiliated with?

If you are a PPO member, you can get care at any hospital, in or out of network, although you will pay more for out-of-network care.

For HMO, EPO and HSP members:

  1. Log in to your member account with your user name and password.
  2. Click on ProviderSearch.
  3. Click on Change Provider Type below Doctor, and select Medical Group.
  4. Enter the name of the medical group in the search field. (Your plan information will already be filled in.)
  5. Click Search. The Medical group detail page will display.
  6. Scroll down to view this group's hospital affiliations.

back to FAQ listHow often are Health Net's online doctor and hospital directories updated?

ProviderSearch is our online directory of all contracted physicians, hospitals and facilities. While ProviderSearch is updated daily, we suggest you contact the doctor you wish to see to verify that they participate in our network and that they are accepting new patients.

Security and Registration Answers

back to FAQ listWhere can I find my Member ID number?

This is also called your Subscriber ID number, and you can find it on your Health Net insurance card. When you register, please enter the complete ID number, including all letters and numbers. 

You can also register if you do not know your ID number.

back to FAQ listWhen I register, should I enter my own date of birth even if I'm not the primary subscriber?

Yes. If you are registering for a member account for yourself, you should enter your own date of birth.

back to FAQ listWhat are the rules for choosing a password?

  • Your password must be at least 6 characters long, but not longer than 15 characters.
  • It must contain at least 1 letter and 1 number, and it must be different from your user name.
  • Some special characters are supported, but not all.
  • When logging in, please note that your password is case sensitive.

back to FAQ listWhy do I need a password security question?

If you forget your password, you will be asked to answer your password security question. We will then email you a temporary password so you can access the website and reset your password.

back to FAQ listWhat if I can't answer my password security question?

If you cannot answer your security question, please Contact us.

back to FAQ listAre there any restrictions on who can and can't use the site?

If you enrolled in a Health Net plan through a state or federal health care marketplace such as Covered CaliforniaTM or the Health Insurance Marketplace in Arizona:

  • You must be 12 years or older to use this site.
  • To log in or register for the Member site, you must be the primary subscriber or a dependent on a Health Net plan, or be the parent or guardian of a minor who is the primary subscriber on a Health Net plan.
  • You may register and log in to the Member site once your initial payment has been processed. However, some site features are hidden until your plan is in effect.
  • You may use the Member site for 18 months after your coverage ends.

For all other users:

  • You must be 12 years or older to use this site.
  • To log in or register for the Member site, you must be the primary subscriber or a dependent on a Health Net policy, or be the parent or guardian of a minor who is the primary subscriber on a Health Net plan.
  • You may register and log in to the Member site beginning on the effective date of your plan and continue using the Member site for 18 months after your coverage ends.

back to FAQ listWhy do I need to choose a Sign-In Seal image?

A Sign-In Seal is a photo that displays on the authentic Health Net website. Look for it every time you log in from a new device or browser, or if you clear your browser’s cookies. Using a Sign-In Seal will ensure you are not on a fraudulent phishing site and it is part of Health Net’s commitment to your information security.

Manage My Account/Profile Answers

back to FAQ listHow do I register for a member account on www.healthnet.com?

  1. Go to the Member Registration page.
  2. Complete the member registration form.
  3. Read and agree to the Terms of Use of this website.
  4. Click Register.

Things you should know before registering:

  • You'll be asked for your Subscriber ID, but you can still register if you don't have it. Your Subscriber ID can be found on your Health Net insurance card. Please enter the complete ID number, including all letters and numbers.
  • Your password must contain a combination of numbers and letters (at least one of each).
    • Your password must be at least 6 characters long, but not longer than 15 characters.
    • It must contain at least 1 letter and 1 number, and it must be different from your user name.
    • Some special characters are supported, but not all.
    • When logging in, please note that your password is case sensitive.
  • Your password and your password hint answer must be different.

back to FAQ listHow do I change my address?

  1. Log in to your member account with your user name and password.
  2. Select the Profile option at the top of the page.
  3. The system will display options to change your contact information.

If your benefits are through your employer, you may be asked to contact your benefits department or plan administrator.

back to FAQ listHow do I get access to view and update information for all enrolled members of the family?

As the primary subscriber, you and a spouse will have access to profile and plan information for all covered members under the age of 18. This includes the ability to update information, as well. All other enrolled family members will need to register, access the Profile option and select Share Plan Access to allow other adult members on the plan to view or make changes to their information.

Medicare Advantage and Medicare Supplement plans are individual plans, not family plans. So if you and a spouse are enrolled in the same Health Net plan, you will only have access to view and update information for your own account.

back to FAQ listHow do I change my primary care physician (PCP)?

Note: PPO, EPO and Medicare Supplement members are not required to select a PCP. Only HMO, HSP and CommunityCare members need to select a PCP of their choice.

In Arizona, HMO, HSP and CommunityCare members are not required to select a PCP.
  1. Log in to your member account with your user name and password.
  2. Go to ProviderSearch, select a new doctor, then click on View Details.
  3. Next, click on SET AS PCP.

You can also change your PCP from your member home page. You'll need your new doctor's ID number.

  1. Log in to your member account with your user name and password.
  2. Go to the member home page.
  3. Click the pencil icon that appears next to MY DOCTOR information, then enter your new doctor's ID number.

back to FAQ listHow do I add or delete family members (newborns, adoptions)?

If you are enrolled in a Health Net Individual or Family plan through Covered California or your state's Health Insurance Marketplace, you may add or delete enrolled family members during your open enrollment period. In addition, we will generally accept enrollments for newly eligible members within 60 days after the following events:

  • A subscriber's marriage or divorce.
  • Death of a subscriber's spouse or dependent.
  • The birth, adoption or placement for adoption or foster care of a child*.
  • Loss of coverage by a subscriber's spouse.
  • Permanent move.
  • Enrollment errors.
  • Violation of material provision of plan contract.
  • Newly eligible/ineligible for advance payment of the premium tax credit or change in eligibility for cost-sharing reductions.

Please note: You must submit with proper documentation to Health Net.

If you are enrolled in an employer sponsored plan, please contact the employer's benefits department for instructions and an enrollment change form, otherwise please contact Health Net Member Services at the number on your ID card.

Medicare Advantage and Medicare Supplement plans are individual plans. If you or your spouse is eligible for Medicare, learn more or apply online for a Health Net Medicare Advantage or Medicare Supplement plan.

*In general, an eligible newborn child (or newly adopted child, or child in foster care) is covered for 31 days from his or her date of birth. To continue coverage beyond this initial period, a child must be enrolled within 31 days of birth or placement. Coverage will not begin until application and premium are received within 31 days after birth or placement. If enrollment of the additional dependent is in a higher premium bracket, an additional premium amount is required.

back to FAQ listHow do I get a new ID card?

  1. Log in to your member account with your user name and password.
  2. Select Order ID Card, or Print Temporary ID Card, from the My Health Plan page.

back to FAQ listWhat if my email address changes?

  1. Log in to your member account with your user name and password.
  2. Select the Profile option at the top of the page.
  3. Click on the pencil icon next to your current email address.
  4. Enter your new email address.

back to FAQ listHow can I change my user name?

  1. Log in to your member account with your user name and password.
  2. Select the Profile option at the top of the page.
  3. Click on the pencil icon next to your current user name.
  4. Enter a new user name.

We suggest that you choose a user name that's easy for you to remember.

Plan Options and Coverage Answers

back to FAQ list How do I find out if a service or procedure is covered?

Check your coverage documents.

  1. Log in to your member account with your user name and password.
  2. Look for the Plan Overview column on the My Health Plan page.
  3. Select the option to View Documents next to the Coverage Document label.
  4. Selecting the linked text will open a PDF version of your coverage document.

If your coverage documents are not available, please call Member Service at the number on your ID card.

back to FAQ list How do I get information on mental and behavioral health care programs?

Most Health Net plan members have access to mental and behavioral health care benefits through MHN, a Health Net company. Please see the back of your ID card or refer to your plan documents for your individual benefits.

back to FAQ listHow do I get information about alternative care, such as chiropractic, acupuncture or massage therapy?

Health Net offers a variety of alternative care benefit options, including discounts and coverage integrated with certain plans.

To find out if your plan includes alternative care coverage, please view your plan documents.

Some Health Net plans also offer Healthy Discounts giving members discounts on alternative care services. To explore these options, log in and visit the Wellness Center, or refer to your plan’s Healthy Discounts brochure.

You can search for alternative care providers using our ProviderSearch tool.

back to FAQ listHow do I find my Explanation of Benefits (EOB)?

Note: We can only supply EOBs for claims processed at Health Net directly.

Please contact your medical group, Medicare, or your primary insurance carrier for assistance with acquiring EOBs for claims they have processed.

For claims processed by Health Net:

  1. Log in to your member account with your user name and password.
  2. Select My Plan Activity from the main navigation bar.
  3. Select Claims from the sub navigation menu.
  4. Search EOB from the list of available page options.

back to FAQ listHow do I file a medical claim?

To download and print a Claim Form:

  1. Log in to your member account with your user name and password.
  2. From My Plan Activity, under the Claims section, select Claim Forms.
  3. Select the appropriate claim form.

You will be asked to provide the bill and proof of payment. For full instructions, see the claim form.

back to FAQ listHow do I find the status of a claim?

  1. Log in to your member account with your user name and password.
  2. Select My Plan Activity from the main navigation bar.
  3. Select Claims.
  4. Select Claims History and view your claims information.

You can also select Search Explanation of Benefits (EOB) from the list of available page options to view your available EOB.

If you need help, you can also call our Member Services at the number on your ID card.

back to FAQ listHow do I find out about member discounts?

Some plans offer Healthy Discounts giving members discounts on fitness clubs, weight management, vision services, alternative care services, and more. To explore these offers, log in and visit the Wellness Center or your plan’s Healthy Discounts brochure.

back to FAQ listHow do HMO, PPO, EPO, and HSP health plans work?

An HMO is a type of health coverage that offers health care services through a network of health care providers. A network is a set group of doctors, hospitals, clinics, labs, and pharmacies. You get care and choose a primary care physician (PCP) from your network. Your PCP will arrange your care and refer you to specialists in the network as needed.

In Arizona, HMO members are not required to select a PCP and may access an in-network specialist without a PCP referral.

An HMO is right for you if:

  • You want your PCP to coordinate and oversee your care.
  • You want less paper work for you.
  • You want lower out-of-pocket costs.

How HMO plans work

Preferred Provider Organization (PPO)

A PPO is also a type of health coverage with a set network of health care providers. You can see providers outside of the network, but you may pay more. You can also go to a specialist without getting a referral.

A PPO is right for you if:

  • You want the option to get services "in" or "out" of your plan’s network.
  • You prefer to go directly to a specialist when you need care.
  • You want to manage your own health care without seeing your PCP first.

How PPO plans work

Exclusive Provider Organization (EPO)

An EPO is a type of health coverage that also has a network of health care providers. Like an HMO, you must use health care providers within your network. But you do not need to select a PCP or get a referral to see a specialist.

An EPO is right for you if:

  • You want more choices of doctors and hospitals but do not want to pay the higher cost for a PPO.
  • You want to see a specialist without a referral.
  • You want to manage your own health care without seeing your PCP first.

How EPO plans work

Health services plan (HSP)

With an HSP, you are required to select a primary care physician (PCP)
for yourself and each covered member of your family, even though you may go directly to any participating provider without first seeing your PCP. You choose a PCP from Health Net’s HSP provider network.

Except for emergency and urgently needed care, you have to use doctors and facilities, like labs, in Health Net’s HSP network.

In Arizona, HSP members are not required to select a PCP and may access an in-network specialist without a PCP referral.

An HSP is right for you if:

  • You want more choices of doctors and hospitals but do not want to pay the higher cost for a PPO.
  • You want to see a specialist without a referral.
  • You want to manage your own health care without seeing your PCP first.

How HSP plans work

Prior Authorization Process Answers

Please note: This general information may not apply to all Health Net plan types. To learn more about your plan benefits, please review your plan documents.

back to FAQ listWhat is a specialist, and how do I get specialist care?

A specialist is a doctor you see for certain types of health conditions. There are many types of specialists, including cardiologists, oncologists and orthopedic surgeons.

Some Health Net plans allow you to access specialists directly, while others may require your primary care physician (PCP) to give you a specialist referral. Check your plan document for details on how to get care from a specialist on your specific plan.

back to FAQ listWhat is a referral, and why is it needed?

Typically, a referral is a request from your PCP for you to see a specialist. Depending on your plan, you may need a referral before you can see a specialist. Health Net may need to approve your referral before your specialist visit. This is called an "authorization."

Examples of referrals can be to an orthopedic surgeon for a back injury, or to a cardiologist for a heart condition.

back to FAQ listWhat is prior authorization?

You may need to get approval from Health Net before you can get certain heath care services. This process is called getting "prior authorization." You can learn more about prior authorization in your plan coverage documents.

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Important Notice

General Purpose
Health Net's National Medical Policies (the "Policies") are developed to assist Health Net in administering plan benefits and determining whether a particular procedure, drug, service, or supply is medically necessary. The Policies are based upon a review of the available clinical information including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the drug or device, evidence-based guidelines of governmental bodies, and evidence-based guidelines and positions of select national health professional organizations. Coverage determinations are made on a case-by-case basis and are subject to all of the terms, conditions, limitations, and exclusions of the Member's contract, including medical necessity requirements. Health Net may use the Policies to determine whether, under the facts and circumstances of a particular case, the proposed procedure, drug, service, or supply is medically necessary. The conclusion that a procedure, drug, service, or supply is medically necessary does not constitute coverage. The Member's contract defines which procedure, drug, service, or supply is covered, excluded, limited, or subject to dollar caps. The policy provides for clearly written, reasonable and current criteria that have been approved by Health Net's National Medical Advisory Council (MAC). The clinical criteria and medical policies provide guidelines for determining the medical necessity criteria for specific procedures, equipment and services. In order to be eligible, all services must be medically necessary and otherwise defined in the Member's benefits contract as described in this "Important Notice" disclaimer. In all cases, final benefit determinations are based on the applicable contract language. To the extent there are any conflicts between medical policy guidelines and applicable contract language, the contract language prevails. Medical policy is not intended to override the policy that defines the Member's benefits, nor is it intended to dictate to providers how to practice medicine.


Policy Effective Date and Defined Terms.
The date of posting is not the effective date of the Policy. The Policy is effective as of the date determined by Health Net. All policies are subject to applicable legal and regulatory mandates and requirements for prior notification. If there is a discrepancy between the policy effective date and legal mandates and regulatory requirements, the requirements of law and regulation shall govern. In some states, prior notice or posting on the website is required before a policy is deemed effective. For information regarding the effective dates of Policies, contact your provider representative. The Policies do not include definitions. All terms are defined by Health Net. For information regarding the definitions of terms used in the Policies, contact your provider representative.


Policy Amendment without Notice.
Health Net reserves the right to amend the Policies without notice to providers or Members. In some states, prior notice or website posting is required before an amendment is deemed effective.


No Medical Advice.
The Policies do not constitute medical advice. Health Net does not provide or recommend treatment to Members. Members should consult with their treating physician in connection with diagnosis and treatment decisions.


No Authorization or Guarantee of Coverage.
The Policies do not constitute authorization or guarantee of coverage of any particular procedure, drug, service, or supply. Members and providers should refer to the Member contract to determine if exclusions, limitations and dollar caps apply to a particular procedure, drug, service, or supply.


Policy Limitation: Member's Contract Controls Coverage Determinations.
Statutory Notice to Members: The materials provided to you are guidelines used by this plan to authorize, modify or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. The determination of coverage for a particular procedure, drug, service, or supply is not based upon the Policies, but rather is subject to the facts of the individual clinical case, terms and conditions of the Member's contract, and requirements of applicable laws and regulations. The contract language contains specific terms and conditions, including pre-existing conditions, limitations, exclusions, benefit maximums, eligibility, and other relevant terms and conditions of coverage. In the event the Member's contract (also known as the benefit contract, coverage document, or evidence of coverage) conflicts with the Policies, the Member's contract shall govern. The Policies do not replace or amend the Member contract.


Policy Limitation: Legal and Regulatory Mandates and Requirements
The determinations of coverage for a particular procedure, drug, service, or supply is subject to applicable legal and regulatory mandates and requirements. If there is a discrepancy between the Policies and legal mandates and regulatory requirements, the requirements of law and regulation shall govern.


Reconstructive Surgery
California Health and Safety Code 1367.63 requires health care service plans to cover reconstructive surgery. "Reconstructive surgery" means surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following:


1. To improve function; or
2. To create a normal appearance, to the extent possible.


Reconstructive surgery does not mean "cosmetic surgery," which is surgery performed to alter or reshape normal structures of the body in order to improve appearance.


Requests for reconstructive surgery may be denied, if the proposed procedure offers only a minimal improvement in the appearance of the enrollee, in accordance with the standard of care as practiced by physicians specializing in reconstructive surgery.


Reconstructive Surgery after Mastectomy
California Health and Safety Code 1367.6 requires treatment for breast cancer to cover prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the copayment, or deductible and coinsurance conditions, that are applicable to the mastectomy and all other terms and conditions applicable to other benefits. "Mastectomy" means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon.


Policy Limitations: Medicare and Medicaid
Policies specifically developed to assist Health Net in administering Medicare or Medicaid plan benefits and determining coverage for a particular procedure, drug, service, or supply for Medicare or Medicaid Members shall not be construed to apply to any other Health Net plans and Members. The Policies shall not be interpreted to limit the benefits afforded Medicare and Medicaid Members by law and regulation.

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Schedule of Benefits Disclaimer

This Schedule of Benefits is a brief list of benefits, with applicable copayments, coinsurance and deductibles information for your health plan. It does not list the exclusions and limitations or other important terms applicable to your plan.

For more information, please review carefully the disclosure form for your plan. It includes additional terms and information on certain exclusions and limitations.

The Evidence of Coverage (EOC) for your plan contains the complete terms and conditions of your Health Net coverage. It is important for you to thoroughly review the disclosure form and EOC for your plan, especially those sections that apply to those with special health care needs. You may view your Evidence of Coverage by: closing the current window and clicking on MY MEDICAL BENEFITS.

You may request copies of the forms referenced above for your health plan by: closing this window and clicking on Contact Us at the top of any web page.
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Add/Delete Members on Your Plan

How do I add or delete family members (ex. newborns,adoptions)?

You may add or delete family members during your open enrollment period. In addition, we will generally accept enrollments for newly eligible members within 30 days after the following events (with proper documentation submitted to us):



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New Year, New Website for You!


Your Health Net Coverage for 2018 comes complete with a brand-new website. The design and menus are easier to navigate. And it's packed with helpful information about your plan, your network and all the extras that come with your coverage.