Group Member Forms and Brochures
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Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
For members on Health Net Health Plan of Oregon, Inc. plans (PDF)
- Coordination of Benefits Form (PDF)
- Out-of-Network Vision Claim Form (PDF)
- Wellness PayBack Claim Form (PDF)
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.
Small Group
- Small Business Group Employee Enrollment and Change Form – 2023 – English (PDF)
- Small Business Group Employee Enrollment and Change Form – 2023 – En Español (Spanish) (PDF)
- Small Business Group Employee Enrollment and Change Form – 2022 – English (PDF)
- Small Business Group Employee Enrollment and Change Form – 2022 – En Español (Spanish) (PDF)
Large Group
- Large Business Group Employee Enrollment and Change Form – 2023 – English (PDF)
- Large Business Group Employee Enrollment and Change Form – 2023 – En Español (Spanish) (PDF)
- Large Business Group Employee Enrollment and Change Form – 2022 – English (PDF)
- Large Business Group Employee Enrollment and Change Form – 2022 – En Español (Spanish) (PDF)
Additional forms
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:
- Health & Wellness Program and Services Guide (PDF)
- Healthy Discounts Booklet (PDF)
- 2022 Wellness Webinar Schedule (PDF)
- myStrength Flyer (PDF)
- Health Net’s Preventive Screening Guidelines – English (PDF)
- Health Net's Preventive Screening Guidelines – Spanish (PDF)
- Preventive Care and Screenings (Facts about ACA-Covered Services) (PDF)
- Active&Fit Enrollment Fee Promotion Flyer (PDF)
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.
- Glossary of Health Coverage and Medical Terms – English (PDF)
- Glossary of Health Coverage and Medical Terms – Spanish (PDF)
- Glossary of Health Coverage and Medical Terms – Chinese (PDF)
- Glossary of Health Coverage and Medical Terms – Navajo (PDF)
- Glossary of Health Coverage and Medical Terms – Korean (PDF)