Eligibility Certification Form
Provider Type
- Physicians
- Hospitals
- Ancillary
- Participating Physician Groups (PPG)
An individual seeking medical attention who claims to be an eligible Health Net member, but who does not have a valid permanent Health Net identification (ID) card, must be questioned by the provider to determine whether the individual is a new member. The provider must contact the Health Net Provider Services Center to verify eligibility, but must not delay providing or authorizing care to a Health Net member. If the individual is determined to be a new member, he or she must sign an Eligibility Certification Form before receiving services.
Health Net Identification Card
All Health Net members are issued a Health Net identification (ID) card. This card serves as identification for medical, prescription medication and vision coverage.
The Health Net ID card should be carried by the member at all times, and must be presented to the physician, hospital or ancillary provider when seeking medical services and at participating Health Net pharmacies when purchasing prescription medications. A member who has lost a Health Net ID card should be advised to call the Health Net Member Services Center to request a replacement card.