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 - Friday except for holidays.
Leaving so soon?
How to use this page
How to Upload and Attach a Document
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, .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.
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.
- Census Information
- Plans offered in your area
- Getting ready to enroll
- Applicant information
- Contact information
- Statement of accountability
- Broker Assistance Details
- Application summary
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
We're sorry, but 2017 plan enrollment is not available on this website.
Optional Coverage Premium Breakdown
Medical Plan Premium Breakdown
Total Monthly Premium Breakdown
Your session has timed out. To protect your privacy, we have cleared out any data you entered on the form.
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 First Name:
Broker Last Name:
Forgot User Name
If you have forgotten your user name, please enter your email address below, and we will send it to you. Please Note: most applicants use their email address as their user name.