For Arizona Brokers
2015 IFP off-exchange enrollment forms must be used when applying for a Health Net of Arizona, Inc. HMO plan or Health Net Life Insurance Company PPO insurance plan.
Applicants who submit/submitted 2014 enrollment forms are being asked to complete a new 2015 form before we can enroll them for coverage. Using a 2014 form may cause a delay and impact their effective date of coverage.
To locate materials: go to the broker portal at healthnet.com > Forms and Brochures > Individual and Family Plan Materials for 2015.
Thank you for your immediate attention. If you have any questions, please contact your account executive or call 1-888-463-4875, option 2.
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