Oregon Large Business Groups
Broker Portfolio Guide
Additional Materials
Employer Group Application
Enrollment and Change Applications
- Employee Enrollment and Change Form - 2020 - English (PDF)
- Employee Enrollment and Change Form - 2020 - Spanish (PDF)
- Employee Enrollment and Change Form - 2019 - English (PDF)
- Employee Enrollment and Change Form - 2019 - Spanish (PDF)
Pharmacy
This kit is for members only and may not be included in Open Enrollment Kits.
- Getting Started With Mail Order Pharmacy Kit - English (PDF)
- Getting Started With Mail Order Pharmacy Kit - Spanish (PDF)
Pharmacy Reimbursement Form
Continuation of Coverage Forms
- Federal Continuation Election Form - COBRA - English (PDF)
- Federal Continuation Election Form - COBRA - Spanish (PDF)
HIPAA Disclosures
- Employer Group Health Plan HIPAA Disclosure Directive (PDF)
- Authorization to Use and Disclose Health Information (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information (PDF)
Additional Forms and Materials
CommunityCare 1T Plans
Combined medical and pharmacy out-of-pocket maximum.
- CC1T10-500-2-4500DX (PDF)
- CC1T10-1500-2-5500DX (PDF)
- CC1T15-1000-2-5500DX (PDF)
- CC1T15-1000-2-6600DX (PDF)
- CC1T20-2000-2-6000DX (PDF)
- CC1T20-2000-2-6600DX (PDF)
- CC1T25-3000-2-7350DX (PDF)
- CC1T25-3000-3-8150DX (PDF)
- CC1T30-5000-3-8150DX (PDF)
- CC1T20-2000-3-6000ES (PDF)
- CC1T35-3000-3-7350ES (PDF)
- CC1T35-5000-3-7350ES (PDF)
- CC1T50-5000-3-7350ES (PDF)
- CC1T50-7000-3-8150ES (PDF)
CommunityCare 1T High Deductible Health Plans
Combined medical and pharmacy out-of-pocket maximum.
- HDECC1T25-3000-2-6600 (PDF)
- HDECC1T35-3000-3-6750 (PDF)
- HDECC1T35-5000-2-6600 (PDF)
- HDECC1T35-5000-3-6600 (PDF)
CommunityCare 3T Plans
Combined medical and pharmacy out-of-pocket maximum.
- CC3T10-0-2-4500DX (PDF)
- CC3T10-500-2-4500DX (PDF)
- CC3T10-750-2-5500DX (PDF)
- CC3T10-1500-2-5500DX (PDF)
- CC3T15-1000-2-5500DX (PDF)
- CC3T20-2000-2-6000DX (PDF)
- CC3T25-3000-2-7350DX (PDF)
- CC3T15-1000-3-5500ES (PDF)
- CC3T20-2000-3-6000ES (PDF)
- CC3T25-3000-3-7350ES (PDF)
- CC3T35-3000-3-7350ES (PDF)
- CC3T35-5000-3-7350ES (PDF)
- CC3T50-5000-3-7350ES (PDF)
- CC3T50-7000-3-8150ES (PDF)
CommunityCare 3T High Deductible Health Plans
Combined medical and pharmacy out-of-pocket maximum.
- HDECC3T25-3000-2-6600 (PDF)
- HDECC3T25-3000-3-6600 (PDF)
- HDECC3T35-5000-2-6600 (PDF)
- HDECC3T35-5000-3-6600 (PDF)
PPO Essentials First Dollar Plans
Combined medical and pharmacy out-of-pocket maximum.
- FE25-1000-2-5000 (PDF)
- FE25-1500-2-7350 (PDF)
- FE30-2000-2-7350 (PDF)
- FE35-3000-2-7350 (PDF)
- FE35-5000-2-7350 (PDF)
- FE50-50-3500 (PDF)
- FE50-50-5000 (PDF)
- FE50-5000-5-7350 (PDF)
- FE5000-3-8150 (PDF)
PPO Essentials
Combined medical and pharmacy out-of-pocket maximum.
- E25-1000-2-5000 (PDF)
- E30-2000-2-6600 (PDF)
- E35-3000-2-7350 (PDF)
- E35-5000-2-7350 (PDF)
- E50-5000-5-7350 (PDF)
- E5000-3-7350 (PDF)
- E5000-5-7350 (PDF)
- E6000-5-8150 (PDF)
- E7000-3-8150 (PDF)
- E7000-5-8150 (PDF)
PPO Advantage Plans
Combined medical and pharmacy out-of-pocket maximum.
- LX20-500-2-4000 (PDF)
- LX25-1000-2-5000 (PDF)
- A15-250-2-4000 (PDF)
- A20-500-2-4000 (PDF)
- A20-750-2-5000 (PDF)
- A20-1000-2-5000 (PDF)
- A20-2000-2-6600 (PDF)
- A25-1000-2-5000 (PDF)
- A30-1500-2-6600 (PDF)
- A30-2500-3-6600 (PDF)
- A30-3000-2-7350 (PDF)
- A35-3000-3-7350 (PDF)
- A35-5000-2-7350 (PDF)
- A35-5000-3-7350 (PDF)
- V20-500-2-4000 (PDF)
- V25-1000-2-5000 (PDF)
- V30-2000-2-6000 (PDF)
- V35-5000-2-7350 (PDF)
- V40-6000-2-8150 (PDF)
PPO Fifty Plans
Combined medical and pharmacy out-of-pocket maximum.
High-Deductible Health Plans
CommunityCare 1T Plans
Combined medical and pharmacy out-of-pocket maximum.
CommunityCare 3T Plans
Combined medical and pharmacy out-of-pocket maximum.
PPO Essentials First Dollar Plans
Combined medical and pharmacy out-of-pocket maximum.
PPO Essentials
Combined medical and pharmacy out-of-pocket maximum.
PPO Advantage Plans
Combined medical and pharmacy out-of-pocket maximum.
- A20-2000-2-6000/XA - English (PDF)
- A20-2000-2-6000/XA - Spanish (PDF)
- A30-3000-2-6600/XA - English (PDF)
- A30-3000-2-6600/XA -Spanish (PDF)
PPO Fifty Plans
Combined medical and pharmacy out-of-pocket maximum.
High-Deductible Health Plans
Alternative Care
- Well Net CAM15-1000 (PDF)
- Well Net CAM15-1000 Plus (PDF)
- Well Net CAM15-1500 (PDF)
- Well Net CAM15-1500 Plus (PDF)
Prescription Drug Riders No MAC
Combined medical and pharmacy out-of-pocket maximum.
- NMSL5-10-25 (PDF)
- NMSL10-20-40 (PDF)
- NMSL10-35-60 (PDF)
- NMSL10-50-75 (PDF)
- NMSL15-30-50 (PDF)
- NMSL15-40-65 (PDF)
- NMSL15-30%-50% (PDF)
Prescription Drug Riders No MAC with deductible
Combined medical and pharmacy out-of-pocket maximum.
Prescription Drug Riders MAC A
Combined medical and pharmacy out-of-pocket maximum.
PPO Vision Plan Overviews
Health Care Reform
PDF provides detailed instructions for distribution and reproduction of the Summary of Benefits and Coverage form required under the Affordable Care Act.
CommunityCare
- Health Net CommunityCare (PDF)
- Facts about Health Net CommunityCare for Members (PDF)
- Health Net CommunityCare Wellness Program (PDF)
- Health Net CommunityCare Wellness Rewards Program (PDF)
Additional Tools
- Healthnet.com (Fast and Easy Way to Manage Your Health) (PDF)
- Teladoc Member FAQs (PDF)
- Think of Teladoc First (PDF)
- Teladoc Mental Health - Getting Started (PDF)
- Sales Guidelines (PDF)
- EFT Set Up Instructions (PDF)
- How To Read Your Commission Statement (PDF)
- Top Reasons to Sell Health Net (PDF)
- Member Handbook - 2020 (PDF)
- ER vs. Urgent Care (PDF)
- Coordination of Benefits Flyer (PDF)
- Secure Messaging Reference Guide (PDF)
- Generic vs Brand-Name Drugs Information (PDF)
- Employer Online Enrollment and Billing (PDF)
- National PPO Network (PDF)
- Health Net Mobile App How-To - English (PDF)
- Health Net Mobile App How-To - Spanish (PDF)
- Your Dental Website from Health Net (PDF)
- Your Vision Website from Health Net (PDF)
Uniform Glossary of Health Coverage and Medical Terms
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. Please log in to request a hard copy of the document by mail.
- Uniform Glossary of Health Coverage and Medical Terms - English (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Spanish (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Chinese (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Navajo (PDF)
- Uniform Glossary of Health Coverage and Medical Terms - Korean (PDF)
- Health and Wellness Program and Services Guide (PDF)
- Online Wellness Programs and Resources (PDF)
- Healthy Discounts (PDF)
- myStrength (PDF)
- Get to Know the Health Coaching Program (PDF)
- Quit Smoking and Using Tobacco (PDF)
- Ready to Lose Weight? (PDF)
- Health Net’s Preventive Screening Guidelines (PDF)
- Active&Fit Direct Member Flyer - English (PDF)
- Active&Fit Direct Member Flyer - Spanish (PDF)