A dependent child who is incapable of self-support due to a continuously disabling illness or injury may be included as a family member on the parent's Helath Net contract. The Disabled Dependent Certification will help us to determine the eligibility of the dependent.
If you have the completed Disabled Dependent Certification, you will be prompted to attach it later in the process.
If you are not prepared to attach the completed document, please download the form and return it to us within 30 days after submitting the application. Send the completed form to us at the following address:
Health Net
PO Box 2348
Rancho Cordova, CA 95741-2348
To protect your privacy, your session will time out in a few minutes. To Keep working on your application, please press any key or mouse over this page.
Call us at:
Enrollment Services Hours:
You can reach us from at
Monday - Saturday except for holidays.
Need help in your language?
This site includes details about deductibles and cost sharing. A deductible is the amount you owe before your health plan begins to pay. Many plan services do not have a deductible. If there is no deductible shown for a service, it may mean that service doesn't have one.
The cost sharing data we provide assumes you are using an In-Network Provider. Cost sharing can be different for Out-of-Network Providers.
Language Assistance
Get helpful language services at no cost to you.
Scan or photograph the document. Using your home scanner or a scanner at a local copy store, scan your document and save it in a format we can accept: .doc, .docx, .pdf, .gif, .jpg, .jpeg or .bmp. You can also upload a photo of the document; please make sure the photo includes the entire document and is clear and readable. You may upload up to 5 attachments with a maximum file size of 8MB for all attachments.
Upload the document or image. First, use the form below to indicate which kind of document you are uploading. Next click the 'Browse' button to find the document or image you want to upload. After you have uploaded one item, it will be automatically attached to your application. At that point, you'll have the option to upload additional items.
Site map
All of the pages in the plan selection and enrollment tool are listed below. To return to a previous step, please use the back button at the bottom of the page.
Get Started
View Plans
Enroll
Finish up
Please correct errors
Please correct the errors on this page before using the Save button. After you have corrected all errors, click the Save button again.
We're sorry, but 2017 plan enrollment is not available on this website.
Your session has timed out. To protect your privacy, we have cleared out any data you entered on the form.
We need more information about your PCP selection. For each applicant on the plan, please do one of the following:
A qualified interpreter should:
(a) have the vocabulary
equivalent of a native speaker that has received an advanced
education (college or university equivalent) in the non-English
language.
(b) be able to demonstrate cultural sensitivity in
their communication, taking into consideration that every language
encompasses a wide range of variation
(c) have native speaker
language skills (native speaker language skills are developed by
growing up or functioning in a language community) and
(d)
have corresponding reading and writing skills in the non-English
language (the reading and writing skills would be demonstrated by
advanced education in the native language).
If your family includes a disabled dependent over 26 years old, we would like to help you enroll. Please call [] to speak to an enrollment specialist.
As part of the enrollment process, you will need to submit proof of your dependent's disability. Download the Proof of Disability form
Thank you for your interest in Health Net plans.
Broker ID:
Broker First Name:
Broker Last Name:
Broker Firm:
Application Saved
Looks like you have a saved application. To complete your enrollment, please log in using the user ID and password create when you saved your online application.
Application Submitted
Your application has already been submitted. To check the status of your application, please login using the user ID and password created during the enrollment process.
Application Previously Submitted
Your application was previously submitted. Please contact us if you have questions about your application.
We would like to return you to where you left off with your online enrollments. However, the effective date of your saved application has passed. Would you like to start a new application?
Question? Please call us at
You can reach us from , Monday - Saturday except for holidays.
We would like to return you to where you left off with your online enrollment. However, there is a problem with your special enrollment period qualifying event date. The event date must be within 60 days of today's date. It is now more than 60 days from the date you entered.
Would you like to start a new application with a different qualifying event or event date?
Question? Please call us at
You can reach us from , Monday - Saturday except for holidays.
Need Help? Call us now at Monday-Friday, (except holidays).
Forgot Password
If you have forgotten your password, we can send you a link to reset it. Please enter your User Name, provide your birth date, and we will send a reset email to the address associated with your User Name.
For a child only plan, the primary applicant is the oldest child. For an individual or family plan, the primary applicant is listed first on the page where you provided birth dates. Other applicants on this page are dependents or spouse/domestic partner.