2015 Arizona Individual & Family Plan Enrollment Forms Available

For Arizona Brokers

Arizona IFP 2015 Applications2015 IFP off-exchange enrollment forms are available on the Broker Forms and Brochure portal for your immediate use as you work with your clients who are enrolling for 2015 coverage.

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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Mike Spasoff