Plan Benefit Materials | Health Net Medicare Advantage for Oregon and Washington

Plan Materials and Forms

 

Listed below are some documents that may be helpful at different times during your membership. 

For PPO Members

Plans CMS# County  Summary of Benefits
Aqua (PPO) H5439 - 010
  • Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill, OR: Clark, WA
Violet 1 (PPO) H5439 - 011
  • Benton, Clackamas, Lane, Linn, Marion, Multnomah,
    Polk, Washington and Yamhill, 
  • OR; Clark, WA
Violet 1 (PPO)

H5439 - 013

  • OR; Douglas, Jackson, Josephine
Violet 2 (PPO) H5439 - 014-001
  • OR: Clackamas, Lane, Multnomah, Washington
Violet 2 (PPO) H5439 - 014-002
  • OR: Benton, Linn, Yamhill
Violet 2 (PPO) H5439 - 014-003
  • OR: Marion, Polk
Violet 2 (PPO) H5439 - 014-004
  • WA: Clark
Violet 2 (PPO) H5439 - 016-001
  • OR: Jackson
Violet 2 (PPO)
H5439 - 016-002
  • OR: Douglas and Josephine
Violet 3 (PPO) H5439 - 015
  • OR: Douglas and Josephine
Violet 4 (PPO) H5439 - 017
  • OR: Lane

For HMO Members

Plans  CMS#  County  Summary of Benefits 
Ruby (HMO) H6815 - 003-001
  • Clackamas, Multnomah & Washington
Ruby (HMO) H6815 - 003-002
  • Benton, Linn, Marion, Polk & Yamhill
Ruby (HMO) H6815 - 003-003
  • Lane 
Ruby (HMO)
H6815 - 005
  • Douglas, Jackson, Josephine
Ruby (HMO)
H6815 - 006
  • Coos, Crook, Deschutes, Jefferson

For PPO Members

Plans CMS# County  Evidence of Coverage
Aqua (PPO)

H5439 - 010

 

 

  • Benton, Clackamas, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill,
    OR; Clark, WA
Violet 1 (PPO) H5439 - 011


  • Benton, Clackamas, Lane, Linn,
    Marion, Multnomah, Polk,
    Washington and Yamhill, OR; Clark, WA
Violet 1 (PPO) H5439 - 013
  • OR: Douglas, Jackson, Josephine
Violet 2 (PPO) H5439 - 014-001
  • OR: Clackamas, Lane, Multnomah, Washington
Violet 2 (PPO) H5439 - 014-002
  • OR: Benton, Linn, Yamhill
Violet 2 (PPO) H5439 - 014-003
  • OR: Marion, Polk
Violet 2 (PPO) H5439 - 014-004
  • WA: Clark
Violet 2 (PPO) H5439 - 016-001
  • OR: Jackson
Violet 2 (PPO) H5439 - 016-002
  • OR: Douglas and Josephine
Violet 3 (PPO) H5439 - 015
  • OR: Douglas and Josephine
Violet 4 (PPO) H5439 - 017
  • OR: Lane

For HMO Members

Plans  CMS#  County  Evidence of Coverage 
Ruby (HMO) H6815 - 003-001
  • Clackamas, Multnomah & Washington
Ruby (HMO) H6815 - 003-002
  • Benton, Linn, Marion, Polk & Yamhill
Ruby (HMO) H6815 - 003-003
  • Lane
Ruby (HMO) H6815 - 005
  • Douglas, Jackson, Josephine
Ruby (HMO) H6815 - 006
  • Coos, Crook, Deschutes, Jefferson


For PPO Members

Plans CMS# County  Low Income Subsidy
Violet 1 (PPO) H5439 - 011
  • Benton, Clackamas, Lane, Linn,
    Marion, Multnomah, Polk, Washington and Yamhill, OR; Clark, WA
Violet 1 (PPO)

H5439 - 013

  • Douglas, Jackson, Josephine
Violet 2 (PPO) H5439 - 014-001
  • OR: Clackamas, Lane, Multnomah, Washington
Violet 2 (PPO) H5439 - 014-002
  • Benton, Linn, Yamhill
Violet 2 (PPO) H5439 - 014-003
  • Marion, Polk
Violet 2 (PPO) H5439 - 014-004
  • WA: Clark
Violet 2 (PPO) H5439 - 016-001
  • Jackson
Violet 2 (PPO) H5439 - 016-002
  • Douglas and Josephine
Violet 3 (PPO) H5439 - 015
  • Douglas and Josephine
Violet 4 (PPO) H5439 - 017
  • Lane

 

For HMO Members

Plans  CMS#  County  Low Income Subsidy
Ruby (HMO) H6815 - 003-001
  • Clackamas,
    Multnomah & Washington
Ruby (HMO) H6815 - 003-002
  • Benton, Linn, Marion,
    Polk & Yamhill
Ruby (HMO) H6815 - 003-003
  • Lane
Ruby (HMO) H6815 - 005
  • Douglas, Jackson, Josephine
Ruby (HMO) H6815 - 006
  • Coos, Crook, Deschutes, Jefferson