Plans for Individuals and
Families
Enrolling Disabled Dependents
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
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Important Disclaimer
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.
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How to Upload and Attach a Document
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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.
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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
- Census Information
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Finish up
- Signature
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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.
About Enrolling in 2017 Plans
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Optional Coverage Premium Breakdown
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PCP Information Missing
We need more information about your PCP selection. For each applicant on the plan, please do one of the following:
- Select a PCP now by clicking the "Launch Provider Search in a New Window" button for that applicant.
- Click "No" for the question "Would you like to select a PCP for (name)?". Health Net will select a PCP for that applicant.
What is a qualified interpreter?
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).
Acceptable proof documents
- Current California driver's license or identification card.
- Current and valid California vehicle registration form in the applicant's name.
- Evidence the applicant is employed in California.
- Evidence the applicant has registered with a public or private employment agency in California.
- Evidence that the applicant has enrolled his or her children in an California school.
- Evidence that the applicant is receiving public assistance in California.
- Voter registration form of receipt, voter notification card or an abstract of a voter registration.
- Current California utility bill in the applicant's name.
- Current California rent or mortgage payment receipt in the applicant's name. Rent receipts provided by a relative shall not be accepted.
- Mortgage deed showing primary residency.
- Lease agreement in the applicant's name.
- Government mail in the applicant's name (SSA statement, DMV notice, etc.).
- Cell phone bill.
- Credit card statement.
- Bank statement or canceled check with printed name and address.
- US Postal Service change of address confirmation letter.
- Moving company contract or receipt showing your address.
- If you're living in the home of another person, like a family member, friend or roommate, you may send a letter/statement from that person stating that you live with them and aren't just temporarily visiting. This person must prove their own residency by including one of the documents listed above.
- If you're homeless or in transitional housing, you may submit a letter or statement from another resident of the same state, stating that they know where you live and can verify that you live in the area and aren't just temporarily visiting. This person must prove their own residency by including one of the documents listed above.
- Letter from a local non-profit social services provider (excluding non-profit health care providers) or government entity (including a shelter) that can verify that you live in the area and aren't just visiting.
Enrolling with Disabled Dependents
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 Details
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Application Previously Submitted
Your application was previously submitted. Please contact us if you have questions about your application.
Your Plan Effective Date has Passed
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.
There is a Problem With Your Qualifying Event Date
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.
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