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Blue Cross PLUS, Blue Cross PPO, Core, High Option
Health Net
Log in; then select "Get things done" and then "Get forms."
Use one of the claim forms below to claim maintenance drug copay adjustments.
- Health Net Claim Form [PDF]
- Health Net Medicare Claim Form [PDF]
Mail the form to:
Health Net, Attn: Pharmacy
P.O. Box 9103
Van Nuys, CA 91409-9103
Delta Dental and PMI
Use only for non-Delta dentist.
Short-term & Supplemental Disability
Contact your local Benefits Office for Forms and assistance
Basic, Supplemental, Dependent Life
Contact your local Benefits Office for Forms and assistance