Health Net logo

Broker – Key Contacts and Broker Support

Account Services Unit

Our Account Services coordinators are available at: 1-800-547-2967, Monday through Friday from 8:00 a.m. to 5:00 p.m., or by email at:

We provide support for Brokers, Employers, General Agents, and Third-Party Administrators to assist with:

  • Benefits inquiries and clarification.
  • Product and plan overview.
  • Claims inquiries including claims submissions for reprocessing.
  • Verifying eligibility.
  • Password resets for brokers or employers.
  • Ordering single copy collateral.
Medicare Sales and Service

Medicare Advantage Sales and Service

Medicare, as well as health care in general, can be confusing, so we're happy to help you with any questions or concerns you may have. Simply contact us using the information listed below.

  • Call our Medicare Broker Services Team at 1-800-708-7646, Monday through Friday, 9:00 a.m. to 5:00 p.m. Pacific time (PT) (excluding holidays) with any questions. You may also email us at
Covered California Exchange Products

Individual & Family Plans (IFP)
Customer Service: 1-888-926-4988
TTY (hearing and speech impaired): 1-888-926-5180

Small Business Group Plans
Customer Service: 1-888-926-5133
TTY (hearing and speech impaired): 1-888-926-5180

Individual & Family Plans

1-800-909-3447, option 1 for brokers, then:

option 1 – Commission questions (all CA market segments, except Medicare).
option 2 – Check status of an IFP application.
option 3 – Questions on the Broker Delinquency Report, ordering supplies, benefits and rates, and broker contracting, as well as other general questions.
option 4 – Questions regarding premium payments (except Medicare).
option 5 – Benefit/claims questions for an active member.

Fax and Email Addresses:

IFP Billing Department:
Fax: (916) 935-4522 | Email:

IFP Enrollment Applications:
Fax: 1-800-977-4161 | Email:

Broker Services:
Fax: 1-877-977-2947 | Email:

Small Business Groups

1-800-447-8812, then:

option 1 – New quotes/proposals.
option 2 – Renewals for existing accounts.
option 3 – Claims issues or benefit questions for an existing account (for brokers, consultant, or employer group administrator).
option 4 – Enrollment status of new group sales.
option 5 – Broker commissions, contracting and appointments.
option 6 – Eligibility or account billing.
option 7 – Provider issues / ID cards / address changes (for members).

SBG Membership fax # for billing and enrollment issues: (916) 935-4420

SBG Account Management fax numbers:
South Team: (818) 676-6297
North Team: 1-800-303-3110

Email for Broker Services:

Large and Mid-Size Groups

1-800-448-4411, option 4

Additional Departmental Contacts

Collections Department for Groups: 1-800-828-2525

Life Insurance Department for questions regarding eligibility and billing:

COBRA Department: 1-800-977-2207, option 2

Help Fight Fraud, Waste and Abuse

Fraud Hotline: 1-800-977-3565
You Can Make a Difference – Report Suspected Fraud

Log In

Please enter your User Name.


You are now leaving Health Net's website for While Health Net believes you may find value in reading the contents of this site, Health Net does not endorse, control or take responsibility for this organization, its views or the accuracy of the information contained on the destination server.

To proceed to, click 'Continue'. To stay on the Health Net website, click 'Cancel'.

If you would prefer to speak to a Health Net representative about this issue, please click here to go to our Customer Service Center page.

Cancel Continue

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.


You are now leaving

Update Your Security Settings

Your account security is important to us. For added protection, please add
two more security question to your account below.