Member Enrollment

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

A Medicare beneficiary must complete and sign the individual election form when enrolling in the Health Net Medicare Advantage (MA) plan. If another person assists the beneficiary in completing the individual election form, that person must also sign the form. If the individual cannot sign, a court-appointed legal guardian or person with durable power of attorney for health care (DPAHC) or designated in a written advance directive, if authorized by state law, must sign. Proof of legal guardian, DPAHC, written advance directive, or proof of authorization by state law is only required when the designated representative is not signing the application that includes the attestation of legal representation. The member's current Medicare coverage continues until the member's coverage with Health Net MA begins.

Generally, the member's enrollment becomes effective the first day of the following month after an election is made. The member's enrollment under any other MA organization or competitive medical plan (CMP) terminates on the effective date of enrollment in the Health Net MA plan. Likewise, enrollment in any other Medicare-contracting health plan or CMP automatically terminates enrollment in the Health Net MA plan.

As long as an individual remains a Health Net MA member, Medicare fee-for-service (FFS) does not process claims for the medical services that the member receives. Health Net MA has financial responsibility for all Medicare-covered health services that the member receives, as long as the member follows the Health Net MA rules stated in these materials and the member's Evidence of Coverage (EOC).

Medicare Advantage HMO

Upon enrollment, Health Net MA members are required to select a Health Net participating primary care physician (PCP) or participating physician group (PPG). The PCP or PPG is responsible for providing or coordinating all of the member's care. By enrolling in the Health Net MA plan, the member agrees to obtain all covered benefits through their Health Net participating PCP or PPG providers, except for emergency, out-of-area urgently needed services, and out-of-area renal dialysis. Additionally, upon enrollment, the member agrees to abide by the rules of Health Net MA.