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Groups 101+ Forms & Brochures – California

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Plan Brochures / Product Overviews


2020 Enhanced Choice Medical Portfolio: 1/1/20 effective

English 98kB   07/31/19


2019 Enhanced Choice Medical Portfolio: 1/1/19 effective

English 116kB   12/11/18


2020 Enhanced Choice Supplemental Portfolio: 1/1/20 effective

English 89kB   07/31/19


2019 Enhanced Choice Supplemental Portfolio: 1/1/19 effective

English 95kB   09/18/18


Large Group Portfolio Book

English 635kB   07/31/19


2020 Starting Line-Up Medical Portfolio: 1/1/20 effective

English 110kB   07/31/19


2019 Starting Line-Up Medical Portfolio: 1/1/19 effective

English 129kB   12/11/18


2020 Starting Line-Up Supplemental Portfolio: 1/1/20 effective

English 61kB   07/31/19


2019 Starting Line-Up Supplemental Portfolio: 1/1/19 effective

English 63kB   09/18/18


Dental and Vision Underwriting Guidelines

English 32kB   11/16/16


Broker PPO Fast Facts

English 82kB   12/12/19


Member Open Enrollment PPO Brochure

English 783kB   12/12/19


EOA Products Broker Brochure

English 175kB   09/13/18


EOA Deductible Plans Broker Flyer

English 63kB   09/29/19


ExcelCare Network Broker Flyer

English 191kB   09/13/18


Presentation Folders

Generic Folder

English 564kB   12/09/19


Open Enrollment Folder

English 231kB   12/10/19

En Español (Spanish) 1.2MB   12/10/19


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

HMO – Open Enrollment Product flyer

English 144kB   12/10/19

En Español (Spanish) 187kB   12/10/19


PPO – Open Enrollment Product flyer

English 155kB   12/10/19

En Español (Spanish) 657kB   12/10/19


POS – Open Enrollment Product flyer

English 144kB   12/10/19

En Español (Spanish) 91kB   12/10/19


Applications and Forms

Enrollment and Change Applications

Employee Enrollment and Change Form

English 1.7MB   01/28/20

En Español (Spanish) 1.1MB   01/28/20

Chinese (Chinese) 1MB   01/28/20

Korean (Korean) 835kB   01/28/20

Vietnamese (Vietnamese) 759kB   01/28/20


Group Service Agreement/Policy Applications

Group Size Attestation Form

English 504kB   12/12/19


Application for Group Service Agreement/Policy

English 286kB   01/27/20


Application for Group Term Life Insurance Policy Form

English 446kB   12/10/19


Claims

Commercial Medical Claim Form

English 1.4MB   01/27/20

En Español (Spanish) 1.2MB   01/27/20


Commercial MHN Claim Form

English 2.9MB   03/28/19


Dental Claim Form

English 2.8MB   04/12/10


Vision Claim Form

English 84kB   04/14/10


Prescription Drug Claim Form

English 661kB   01/07/20

En Español (Spanish) 654kB   01/07/20


Transition of Care

Continuity of Care Assistance Request Form

English 2.6MB   01/24/20

En Español (Spanish) 932kB   01/24/20


Prescription Transition form

English 487kB   09/30/19

En Español (Spanish) 488kB   09/30/19


Health Net Life Insurance Forms

Employee Enrollment and Change Form

English 983kB   12/10/19

En Español (Spanish) 612kB   12/10/19


Group Life Insurance Conversion Form

English 183kB   12/10/19


Evidence of Insurability Life Form

English 680kB   12/10/19


Employer Life Insurance Claim Form

English 365kB   12/10/19

En Español (Spanish) 256kB   12/10/19


Member Life Insurance Waiver of Premium Claim Form

English 587kB   12/10/19


Broker and Employer Forms

HIPAA Disclosures

Group Health Plan HIPAA Disclosure Forms

Disclosure Directive 157kB   05/22/18

Large Group Claims Data Request & Attestation 105kB   05/22/18


Authorization For Disclosure of PHI

English 568kB   05/29/19

En Español (Spanish) 558kB   05/29/19

Chinese (Chinese) 769kB   05/29/19

Korean (Korean) 671kB   05/29/19


Support Tools

Health Care Reform Materials

Summary of Benefits and Coverage (SBC) Instructions Sheet

English 46kB   12/12/19


Summary of Benefits and Coverage (SBC) Search Flyer

English 385kB   03/13/15


Questions to Help Determine Grandfathered Plan Status (Employer)

English 54kB   11/22/10


Preventive Care Services (ACA Non-Grandfathered Plans)

English 793kB   12/12/19

En Español (Spanish) 597kB   12/10/19


SmartCare

SmartCare Broker Brochure

English 758kB   09/13/18


SmartCare Employer Flyer

English 351kB   09/13/18


MinuteClinic Brochure

English 796kB   12/10/19


Support Tools

Commercial Sales Guidelines

English 272kB   12/12/19


Large Group Employer Guide

English 24.1MB   03/09/20


Top Reasons for Health Net: Employer version

English 265kB   07/31/19


Health Net Financial Strength and Stability

English 102kB   12/12/19


Top Reasons for Health Net: Broker version

English 223kB   07/31/19


Heal flyer (PPO, POS and EOA plans only)

English 1.4MB   10/17/18

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


Teladoc (Telehealth) Introductory Flyer

English/Spanish 327kB   12/10/19


Teladoc (Telehealth) FAQs

English 230kB   12/10/19

En Español (Spanish) 278kB   12/10/19


Teladoc Caregiver flyer

English 2MB   12/10/19


Teladoc Caregiver FAQs

English 401kB   12/10/19


Active&Fit Direct Member Flyer

English 2MB   12/10/19

En Español (Spanish) 2MB   12/10/19


Understanding the Continuity of Care Assistance Policy

English 1.1MB   12/12/19


ID Card Express Program

English 742kB   03/25/19


Summary of Benefits Coverage (SBC) Employer Group Instructions Sheet

English 52kB   08/08/19


HealthNet.com Flyer

English 360kB   12/09/19

En Español (Spanish) 1.3MB   01/14/19


ER vs. Urgent Care

English/Spanish 222kB   12/10/19


Uniform Glossary of Health Coverage and Medical Terms

English 117kB   07/22/16

En Español (Spanish) 138kB   07/22/16

Chinese (Chinese) 447kB   07/22/16

Navajo 230kB   07/22/16

Korean (Korean) 1.2MB   07/22/16

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

Health Net Beginnings

English 66kB   12/12/19

En Español (Spanish) 140kB   12/10/19


Online Support Tools

Secure Messaging Reference Guide

English 887kB   04/03/15


Group Administrator Registration Guide

English 995kB   01/28/20


EFT Set Up Instructions

English 1.6MB   02/20/20


Broker Book of Business Instructional Guide

English 1.6MB   12/01/16


Employer Online Billing and Enrollment Brochure

English 417kB   07/26/18


Health Net Mobile App How-To guide

English 179kB   03/19/20


Flu Shot Flyer

English 551kB   12/10/19

En Español (Spanish) 600kB   12/10/19


First Health National (Out-of-State) PPO

First Health Physician Nomination Form

English 185kB   01/14/20


Broker First Health National PPO Network FAQ

English 764kB   12/10/19


Member First Health National PPO Network FAQ (for groups renewing before 1/1/2019)

English 379kB   12/10/19


Member First Health National PPO Network FAQ (for groups renewing after 1/1/2019)

English 617kB   12/10/19


Pharmacy


Pharmacy Benefits Member Guide

English 880kB   09/30/19

En Español (Spanish) 1.1MB   01/07/20


Mail Order Pharmacy and Maintenance Choice® Program

English 652kB   01/07/20

En Español (Spanish) 594kB   01/07/20


Generic vs Brand-Name Drugs Information

English 90kB   01/07/20


Coverage of Blood Glucose Test Strips - For New Members

English 608kB   01/07/20


Take Medications the Right Way

English 90kB   09/30/19


Getting Started With Mail Order Pharmacy Kit

English 287kB   01/07/20

En Español (Spanish) 303kB   01/07/20


Salud con Health Net


Salud Hmo y Más service area

English 135kB   12/12/19


Broker/Employer

Salud con Health Net Overview

English 199kB   09/13/18


Member

Salud HMO y Más Brochure

Eng/Span 2.8MB   12/09/19


Supplemental Coverage


Broker Supplemental Benefit Multi-Bundling Flyer

English 89kB   07/31/19


Dental Materials

Dental Provider Search Flyer

English 554kB   12/12/19


Your Dental Website (member)

English 169kB   12/19/19


Vision Materials
Effective 2/1/20 Sears Optical, JC Penney Optical and Stanton Optical will no longer be in the EyeMed network.

PPO Vision FAQ

English 874kB   12/12/19


Vision Website (member)

English 147kB   12/12/19


Health Net Life

Basic Life Insurance with AD&D

English 1.6MB   12/19/19

These forms are customizable to allow for the addition of benefit level.


Basic Life Insurance no AD&D

English 2.4MB   12/19/19

These forms are customizable to allow for the addition of benefit level.


Decision Power / Wellness – Member


Decision Power™ Member Brochure

English 1MB   10/01/19

En Español (Spanish) 6.5MB   10/01/19


Wellness Online

English 654kB   10/01/19

En Español (Spanish) 1.5MB   10/01/19


Healthy Discounts Member Flyer

English 680kB   10/01/19

En Español (Spanish) 682kB   10/01/19


Wellness Incentive Member Brochure and FAQ

English 1.1MB   09/11/19

En Español (Spanish) 1.4MB   09/11/19


myStrength Program Flyer

English 568kB   10/01/19

En Español (Spanish) 853kB   10/01/19


Health Coaching Program Flyer

English 537kB   10/01/19


Smoking and Tobacco Cessation

English 513kB   10/01/19

En Español (Spanish) 519kB   10/01/19


Tips to Stop Smoking

English & Spanish 55kB   10/01/19


Decision Power Ready to Lose Weight?

English 511kB   10/01/19

En Español (Spanish) 514kB   10/01/19


Preventive Screening Guidelines – Web PDF only

English 284kB   12/10/19

En Español (Spanish) 429kB   12/10/19


Text4Baby Flyer - PDF Only

English 114kB   12/10/19

En Español (Spanish) 119kB   12/10/19

Promotional flyer and press releases for Health Net's new "Text4Baby" program. This new service provides the expectant mother with 3 free text messages a week, providing helpful information throughout her pregnancy and for baby's first year.


Decision Power / Wellness – Employer / Broker

Broker / Employer Materials

Decision Power Employer/Broker Toolkit

English 593kB   10/01/19


Wellness Rewards Program Broker Flyer

English 72kB   07/31/19


Wellness Rewards Program Employer FAQ

English 32kB   07/31/19


National Observances Calendar for Employers

English 1.8MB   01/29/20


Wellness Webinar flyer for Employers

English 197kB   02/04/20


Wellness Seminars Menu

English 253kB   09/13/18


Additional Forms/Brochures

Travel Guides

HMO/POS Travel Guide

English 3.7MB   10/04/19

En Español (Spanish) 2.3MB   10/04/19

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


PPO Travel Guide

English 1.4MB   12/10/19

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


Additional Materials

Understanding your Explanation of Benefits (EOB) (English/Spanish)

English 403kB   10/09/19


Out-of-Pocket Maximum Notification (PDF)

English 513kB   07/23/19


Understanding Your Billing Statement

English 336kB   08/26/16

Download only


HSA-Compatible PPO


HSA Employer Brochure

English 142kB   10/17/19


HSA Member Brochure

English 974kB   12/10/19


Bank of America HSA Enrollment Packet

English 124kB   01/29/19


2020 – STARTING LINE-UP (SLU) MEDICAL AND MENTAL HEALTH PLAN OVERVIEWS

HMO
(combined medical and pharmacy OOPM)

15/0 (FWT)

English 451kB   07/30/19


10/250a (FWS/FXC)

English 451kB   07/30/19


15/250a (FWU/FXD)

English 451kB   07/30/19


15/1500d (FWV/FXE)

English 500kB   07/30/19


20/250a (FWX/FXG)

English 452kB   07/30/19


20/500a (FWY/FXH)

English 452kB   07/30/19


20/500d (FWZ)

English 452kB   07/30/19


20/20% (FWW/FXF)

English 451kB   07/30/19


30/1000a (FX3/FXL)

English 452kB   07/30/19


30/20% (FX0/FXI)

English 452kB   07/30/19


30/30% (FX1/FXJ)

English 451kB   07/30/19


30/250d (FX2/FXK)

English 452kB   07/30/19


40/20% (FX4)

English 452kB   07/30/19


40/30% (FX5/FXM)

English 452kB   07/30/19


40/40% (FX6/FXN)

English 452kB   07/30/19


40/500d (FX7/FXO)

English 452kB   07/30/19


50/1500d (FX8/FXP)

English 512kB   07/30/19


60/1500a (FX9/FXQ)

English 452kB   07/30/19


60/1500a/8150 (FXB/FXR)

English 452kB   07/30/19


POS-Elect Open Access (EOA)
(combined medical and pharmacy OOPM)

10/0 (G4W)

English 452kB   07/30/19


10/250A (G4X/G5H)

English 452kB   07/30/19


15/250a (G4Y/G5I)

English 452kB   07/30/19


15/1500d (G4Z/G5J)

English 498kB   07/30/19


20/250a (G51/G5L)

English 452kB   07/30/19


20/500a (G52/G5M)

English 452kB   07/30/19


20/500d (G53)

English 452kB   07/30/19


20/20% (G50/G5K)

English 452kB   07/30/19


30/250d (G57/G5P)

English 452kB   07/30/19


30/1000a (G58/G5Q)

English 452kB   07/30/19


30/20% (G54/G5N)

English 452kB   07/30/19


30/30% (G56/G5Y)

English 452kB   07/30/19


40/20% (G59/G5R)

English 452kB   07/30/19


40/30% (G5B/G5S)

English 452kB   07/30/19


40/40% (G5C/G5T)

English 452kB   07/30/19


40/500d (G5D/G5U)

English 452kB   07/30/19


50/1500d (G5E/G5V)

English 498kB   07/30/19


60/1500a (G5F/G5W)

English 452kB   07/30/19


60/1500a/8150 (G5G/G5X)

English 452kB   07/30/19


POS-Elect Open Access (EOA)- Facility Deductible
(combined medical and pharmacy OOPM)

30/1500/30%/3000 (GGE/GGH)

English 552kB   09/16/19


40/3000/40%/5500 (GGF/GGI)

English 552kB   09/16/19


60/4000/40%/8150 (GGG/GGJ)

English 553kB   09/16/19


SmartCare HMO
(combined medical and pharmacy OOPM)

10/250a (FWD)

English 451kB   07/30/19


15/250a (FWF)

English 450kB   07/30/19


15/1500d (FWG)

English 451kB   07/30/19


20/500a (FWI)

English 450kB   07/30/19


20/20 (FWH)

English 450kB   07/30/19


30/250d (FWL)

English 451kB   07/30/19


30/20 (FWJ)

English 450kB   07/30/19


30/30 (FWK)

English 450kB   07/30/19


40/500d (FWN)

English 451kB   07/30/19


40/40 (FWM)

English 450kB   07/30/19


50/50% (FWO)

English 450kB   07/30/19


50/1500d (FWP)

English 461kB   11/26/19


60/1500a (FWQ)

English 450kB   07/30/19


60/1500a/8150 (FWR)

English 450kB   07/30/19


Salud HMO y Mas
(combined medical and pharmacy OOPM)

10/250a (G5Z/G60)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


15/250a (G61/G62)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


15/1500d (G63/G64)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


20/20% (G65/G66)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


20/500a (G67/G68)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


30/20% (G69/G6B)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


30/30% (G6C/G6D)

English 454kB   07/30/19

En Español (Spanish) 591kB   10/15/19


30/250d (G6E/G6F)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


40/40% (G6G/G6H)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


40/500d (G6I/G6J)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


50/1500d (G6K/G6L)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


60/1500a (G6O/G6P)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


60/1500a/8150 (G6M/G6N)

English 454kB   07/30/19

En Español (Spanish) 592kB   10/15/19


Salud Mexico

5/0 (G6Q)

English 452kB   08/01/19


PPO
(combined medical and pharmacy OOPM)

10/0/90/70 (FVE)

English 551kB   08/20/19


10/0/90/70/3000 (FVF)

English 551kB   07/30/19


10/250/90/70 (FVG)

English 557kB   07/30/19


10/250/80/60 (FVH)

English 557kB   07/30/19


15/250/90/70 (FVI)

English 557kB   07/30/19


15/500/90/70 (FVJ)

English 557kB   07/30/19


15/500/80/60 (FVK)

English 548kB   07/30/19


20/250/90/70 (FVL)

English 557kB   07/30/19


20/250/80/60 (FVM)

English 548kB   07/30/19


20/500/80/60 (FVN)

English 156kB   11/26/19


30/500/90/70 (FVO)

English 557kB   07/30/19


30/500/80/60 (FVP)

English 556kB   07/30/19


30/1000/80/60 (FVR)

English 557kB   07/30/19


30/500/70/50 (FVQ)

English 556kB   07/30/19


30/2000/70/50 (FVT)

English 556kB   07/30/19


30/3000/70/50 (FVU)

English 556kB   07/30/19


30/4000/70/50 (FVX)

English 556kB   07/30/19


30/1000/80/60/4000 (FVS)

English 556kB   07/30/19


30/3000/70/50/6000 (FVV)

English 556kB   07/30/19


30/4000/70/50/6600 (FVW)

English 556kB   07/30/19


60/5000/70/50 (FVY)

English 557kB   07/30/19


60/5000/70/50/8150 (FVZ)

English 558kB   07/30/19


PPO HSA-Compatible

2800/70/50 (FW9)

English 556kB   07/30/19


1500/70/50 (FWC)

English 555kB   07/30/19


2800/70/50 (FW5)

English 556kB   07/30/19


2800/100/50/2800 (FW0)

English 556kB   07/30/19


2800/70/50/5000 (FW6)

English 556kB   07/30/19


3000/70/50 (FW7)

English 556kB   07/30/19


2800/100/50 (FW8)

English 597kB   11/26/19


2000/100/50 (FWB)

English 596kB   11/26/19


3000/100/50 (FW1)

English 555kB   07/30/19


3000/80/60 (FW3)

English 557kB   07/30/19


5000/80/60 (FW4)

English 557kB   07/30/19


4000/100/50 (FW2)

English 556kB   07/30/19


2020 – STARTING LINE-UP (SLU) PHARMACY, Chiropractic AND Acupuncture PLAN OVERVIEWS

Pharmacy HMO
(combined medical and pharmacy OOPM)

$100 deductible ($10/$30/$50)-75E-75F-75G-75I-75J-75K-75L

English 601kB   08/02/19


No deductible ($15/$35/$55)-75M- 75N- 75P-75Q-75R-75S-75T

English 602kB   08/02/19


$100 deductible ($15/$35/$55)-75U- 75V- 75X-75Y-75Z-76A-76B

English 601kB   08/02/19


$300 deductible ($15/$40/$60)-76C- 76D- 76F-76G-76H-76I-76J

English 601kB   08/02/19


No deductible ($10/$30/$50)-74W- 74X- 74Z-75A-75B-75C-75D

English 601kB   08/02/19


$300 deductible ($20/$40/$60)-76K- 76L- 76N-76O-76P-76Q-76R

English 601kB   08/02/19


Pharmacy POS- Elect Open Access (EOA)/ExcelCare EOA
(combined medical and pharmacy OOPM)

No deductible ($15/$35/$55)-73G-73H-73I-73J-73K-73L-73M

English 601kB   08/02/19


$100 deductible ($10/$30/$50)-73N-73O-73P-73Q-73R-73S-73T

English 601kB   08/02/19


$100 deductible ($15/$35/$55)-74P-74Q-74R-74S-74T-74U-74V

English 601kB   08/02/19


$300 deductible ($15/$40/$60)-73U-73V-73W-73X-73Y-73Z-74A

English 601kB   08/02/19


No deductible ($10/$30/$50)-74B-74C-74D-74E-74F-74G-74H

English 601kB   08/02/19


$300 deductible ($20/$40/$60)-74I-74J-74K-74L-74M-74N-74O

English 601kB   08/02/19


Pharmacy HMO- Salud HMO y Mas
(combined medical and pharmacy OOPM)

No deductible ($5/$25/$45)-71X-71Y-71Z-72A-72B-72C-72D

English 599kB   07/30/19


No deductible ($10/$30/$50)-72E-72F-72G-72H-72I-72J-72K

English 599kB   07/30/19


$100 deductible ($15/$35/$55)-72L-72M-72N-72O-72P-72Q-72R

English 599kB   07/30/19


$300 deductible ($20/$40/$60)-72S-72T-72U-72V-72W-72X-72Y

English 599kB   07/30/19


$300 deductible ($15/$40/$60)-72Z-73A-73B-73C-73D-73E-73F

English 599kB   07/30/19


Pharmacy PPO
(combined medical and pharmacy OOPM)

No deductible ($10/$30/$50)- 76S-76T-76U-76V-76W-76X-76Y-76Z-77A-77B-77C-77D-77E-77F-77G-77H-77I-77J

English 597kB   08/01/19


$300 deductible ($15/$40/$60)-79M-79N-79O-79P-79Q-79R-79S-79T-79U-79V-79W-79X-79Y-79Z-80A-80B-80C-80D-81C-81D

English 597kB   08/01/19


No deductible ($15/$35/$55) 78C-78D-78E-78F-78G-78H-78I-78J-78K-78L-78M-78N-78O-78P-78Q-78R-78S-78T

English 245kB   10/14/19


$100 deductible ($10/$30/$50)-77K-77L-77M-77N-77O-77P-77Q-77R-77S-77T-77U-77V-77W-77X-77Y-77Z-78A-78B

English 597kB   08/01/19


$100 deductible ($15/$35/$55)-78U-78V-78W-78X-78Y-78Z- 79A-79B-79C-79D-79E-79F-79G-79H-79I-79J-79K

English 596kB   08/01/19


Pharmacy PPO- HSA compatible
(combined medical and pharmacy OOPM)

$2,800 deductible ($15/$35/$55)-80K-80L-80M-80N-81A-81B

English 597kB   08/01/19


$1,500 deductible ($15/$35/$55)ind-80O-80P

English 597kB   08/01/19


$3,000 deductible ($10/$30/$50)-80W-80X

English 597kB   08/01/19


$5,000 deductible ($10/$30/$50)-80Y-80Z

English 597kB   08/01/19


$2,800 deductible ($0/$0/$0)-80Q-80R-80S-80T

English 597kB   08/01/19


$2,000 deductible ($0/$0/$0)-80U-80V

English 611kB   08/01/19


$3,000 deductible ($0/$0/$0)-80G-80H

English 596kB   08/01/19


$3,000 deductible ($15/$35/$55)-80E-80F

English 597kB   08/01/19


$4,000 deductible ($0/$0/$0)-80I-80J

English 397kB   03/30/20


Chiropractic/Acupuncture

Chiropractic/Acupuncture Combined – HMO/ EOA

English 1.2MB   12/10/19


Chiropractic/Acupuncture Combined – SmartCare

English 1.2MB   12/10/19


Chiropractic/Acupuncture Combined – Custom

English 1.4MB   12/10/19


Chiropractic Care

Chiropractic Care – HMO/ EOA

English 1.2MB   12/10/19


2020 – STARTING LINE-UP (SLU) DENTAL & VISION PLAN OVERVIEWS

Dental – HMO

Health Net Plus 85 – Plan Overview

English 504kB   01/22/20


Health Net Plus 85 – Schedule of Benefits

English 232kB   10/04/18


Health Net Plus 100 – Plan Overview

English 481kB   01/22/20


Health Net Plus 100 – Schedule of Benefits

English 231kB   10/04/18


Health Net Plus 150 – Plan Overview

English 458kB   01/22/20


Health Net Plus 150 – Schedule of Benefits

English 262kB   10/04/18


Health Net Plus 185 – Plan Overview

English 503kB   01/22/20


Health Net Plus 185 – Schedule of Benefits

English 976kB   10/04/18


Health Net Plus 225 – Plan Overview

English 536kB   01/22/20


Health Net Plus 225 – Schedule of Benefits

English 1.9MB   10/04/18


Dental – PPO

Classic 1 1500

English 1.5MB   03/11/20


Classic 2 1500

English 1.5MB   03/11/20


Classic 3 1500

English 1.7MB   03/11/20


Classic 4 1500

English 1.5MB   03/11/20


Classic 5 1500

English 1.5MB   03/11/20


Classic 6 1500

English 1.5MB   03/11/20


Classic Plus 1 2000

English 1.3MB   03/11/20


Classic Plus 2 2000

English 1.7MB   03/11/20


Essential 1 1000

English 1.7MB   03/11/20


Essential 2 1000

English 1.8MB   03/11/20


Essential 3 1000

English 1.8MB   03/11/20


Essential 4 1000

English 1.7MB   03/11/20


Essential 5 1500

English 1.7MB   03/11/20


Essential 6 1500

English 1.7MB   03/11/20


Essential Value 1 1000

English 1.8MB   03/11/20


Basic 500

English 1.5MB   03/11/20


Vision Plans

Exam Only

English 760kB   12/10/19


Elite 1010-1

English 808kB   12/10/19


Plus 20-1

English 529kB   12/10/19


Preferred 1025-2

English 515kB   12/10/19


Preferred 1025-3

English 547kB   12/10/19


Preferred Value 10-3

English 504kB   12/10/19


Supreme 010-2

English 587kB   12/10/19


2019 – STARTING LINE-UP (SLU) MEDICAL AND MENTAL HEALTH PLAN OVERVIEWS

HMO

10/250a (FEZ/FGD)

English 673kB   12/20/18


15/0 (FF0)

English 636kB   09/26/18


20/20% (FF1/FGE)

English 636kB   09/26/18


20/250a (FF2/FGF)

English 636kB   09/26/18


20/500a (FF3/FGG)

English 636kB   09/26/18


20/500d (FF4)

English 636kB   09/26/18


30/20% (FF5)

English 636kB   09/26/18


30/30% (FF6/FGH)

English 636kB   09/26/18


30/1000a (FF7/FGI)

English 636kB   09/26/18


40/20% (FF8)

English 636kB   09/26/18


40/30% (FF9/FGJ)

English 636kB   09/26/18


40/40% (FFB/FGK)

English 636kB   09/26/18


50/1500d (FFC/FGL)

English 636kB   09/26/18


60/1500a (FFD/FGM)

English 636kB   09/26/18


60/1500a/7900 (FFE/FGN)

English 636kB   09/26/18


POS-Elect Open Access (EOA)

10/0 (FDX)

English 647kB   12/20/18


10/250a (FDY/FGO)

English 681kB   12/20/18


15/250a (FDZ/FGP)

English 647kB   12/20/18


20/20% (FE0/FGQ)

English 686kB   12/20/18


20/250a (FE1/FGR)

English 647kB   12/20/18


20/500a (FE2/FGS)

English 647kB   12/20/18


20/500d (FE3)

English 647kB   12/20/18


30/20% (FE4/FGT)

English 647kB   12/20/18


30/30% (FE5/FGU)

English 647kB   12/20/18


30/1000a (FE6/FGV)

English 731kB   12/20/18


40/20% (FE7/FGW)

English 647kB   12/20/18


40/30% (FE8/FGX)

English 647kB   12/20/18


40/40% (FE9/FGY)

English 647kB   12/20/18


50/1500d (FEB/FGZ)

English 647kB   12/20/18


60/1500a (FEC/FH0)

English 681kB   12/20/18


60/1500a/7900 (FEF/FH1)

English 647kB   12/20/18


Salud HMO y Mas

10/250a (FEH/FEQ)

English 669kB   12/20/18

En Español (Spanish) 654kB   02/06/19


15/20% (FEI/FER)

English 635kB   09/26/18

En Español (Spanish) 653kB   02/06/19


15/250a (FEJ/FES)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


30/20% (FEK/FET)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


30/30% (FEL/FEU)

English 635kB   09/26/18

En Español (Spanish) 653kB   02/06/19


40/40% (FEM/FEV)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


50/1500d (FEN/FEW)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


60/1500a (FEO/FEX)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


60/1500a/7900 (FEP/FEY)

English 635kB   09/26/18

En Español (Spanish) 654kB   02/06/19


SmartCare HMO

10/250a (FDN)

English 670kB   12/20/18


15/250a (FDO)

English 663kB   12/20/18


20/20% (FDP)

English 663kB   12/20/18


20/500a (FDQ)

English 629kB   09/26/18


30/250d (FDR)

English 629kB   09/26/18


40/500d (FDS)

English 629kB   09/26/18


50/50% (FDT)

English 629kB   09/26/18


50/1500d (FDU)

English 629kB   09/26/18


60/1500a (FDV)

English 629kB   09/26/18


60/1500a/7900 (FDW)

English 629kB   09/26/18


PPO

10/0/90/70 (FFF)

English 743kB   01/08/19


10/0/90/70/3000 (FFG)

English 738kB   01/08/19


10/250/80/60 (FFH)

English 735kB   01/08/19


10/250/90/70 (FGC)

English 683kB   01/08/19


15/250/90/70 (FFI)

English 683kB   01/08/19


15/500/80/60 (FFJ)

English 683kB   01/08/19


15/500/90/70 (FFK)

English 736kB   01/08/19


20/250/80/60 (FFL)

English 684kB   01/08/19


20/250/90/70 (FFM)

English 684kB   01/08/19


20/500/80/60 (FFN)

English 684kB   01/08/19


30/500/70/50 (FFO)

English 739kB   01/08/19


30/500/80/60 (FFP)

English 684kB   01/08/19


30/500/90/70 (FFQ)

English 683kB   01/08/19


30/1000/80/60 (FFR)

English 684kB   01/08/19


30/1000/80/60/4000 (FFS)

English 683kB   01/08/19


30/2000/70/50 (FFT)

English 684kB   01/08/19


30/3000/70/50 (FFU)

English 683kB   01/08/19


30/3000/70/50/6000 (FFV)

English 683kB   01/08/19


30/4000/70/50 (FFW)

English 683kB   01/08/19


30/4000/70/50/6600 (FFX)

English 684kB   01/08/19


60/5000/70/50 (FFY)

English 705kB   02/15/19


60/5000/70/50/7900 (FFZ)

English 705kB   02/15/19


PPO HSA-Compatible

hsa_F_2700_70_50_3000 (FG3)

English 717kB   01/08/19


hsa_I_1500_70_50_3000 (FG0)

English 717kB   01/08/19


hsa_2700_70_50_5000 (FHT)

English 717kB   01/08/19


hsa_2700_100_50_2700 (FG4)

English 835kB   01/09/19


hsa_2700_70_50_3000 (FG2)

English 717kB   01/08/19


hsa_3000_70_50_5000 (FG6)

English 751kB   01/09/19


hsa_F_2700_100_50_2700 (FG5)

English 913kB   01/09/19


hsa_I_2000_100_50_2000 (FG1)

English 795kB   01/08/19


hsa_3000_100_50_3000 (FG8)

English 774kB   01/09/19


hsa_3000_80_60_4000 (FG7)

English 873kB   01/09/19


hsa_5000_80_60_6000 (FGB)

English 792kB   01/09/19


hsa_4000_100_50_4000 (FG9)

English 801kB   01/09/19


2019 – STARTING LINE-UP (SLU) PHARMACY, Chiropractic AND Acupuncture PLAN OVERVIEWS

Pharmacy HMO HMO- HMO/SmartCareHMO/ExcelCare HMO
(combined medical and pharmacy OOPM)

$100 deductible ($10/$30/$50)-60A-60D-20E-60F-60G-60H-60I-60J-60K

English 160kB   10/16/18


No deductible ($15/$35/$55)-60W-60Z-61A-61B-61C-61D-61E-61F-61G

English 160kB   10/16/18


$100 deductible ($15/$35/$55)-61H-61K-61L-61M-61N-61O-61P-61Q-61R

English 160kB   10/16/18


$300 deductible ($15/$40/$60)-61S-61V-61W-61X-61Y-61Z-62A-62B-62C

English 207kB   10/24/18


No deductible ($10/$30/$50)-62P-62S-62T-62U-62V-62W-62X-62Y-62Z

English 160kB   10/16/18


$300 deductible ($20/$40/$60)-63A-63D-63E-63F-63G-63H-63I-63J-63K

English 160kB   10/16/18


Pharmacy POS- Elect Open Access (EOA)/ExcelCare EOA
(combined medical and pharmacy OOPM)

No deductible ($15/$35/$55)-63L-63P-63R-63T-63U-63V

English 591kB   10/16/18


$100 deductible ($10/$30/$50)-63W-64A-64C-64E-64F-64G

English 591kB   10/16/18


$100 deductible ($15/$35/$55)-64H-64L-64N-64P-64Q-64R