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Group Member Forms and Brochures

To view or download a file below, click the topic heading, then click the desired document link. The PDF file will open in your current browser window. From there, you can also download or print the file.

Complete the claim form for each member submitting bills for reimbursement of covered services. To avoid any delay, be sure to answer each question completely. PLEASE ATTACH FULLY ITEMIZED BILLS AND PROOF OF PAYMENT.

Member Reimbursement Claim Form (PDF)

Mail Order Pharmacy

Getting Started With Mail Order Pharmacy Kit

CVS Caremark Mail Order Pharmacy

Medication Therapy Management

Prescription Claims

Approved Drug Lists

The drug list, or formulary, is a list of covered drugs selected by Health Net, along with a team of health care providers. These drugs are selected because they are believed to be a necessary part of a quality treatment program. Our drug lists are updated regularly and are subject to change.

Essential Health Benefit Drug Lists for Group Plans:

For Washington State members only

The state of Washington recently finalized regulations, effective January 1, 2021, allowing you to request that we change your phone number or address so all your communication with us is confidential. If you choose to make that change, please visit the Washington insurance website. Note: all communications with you will be either to your new phone number, new address or both.

For more information, please visit the rule's webpage

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.