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

Plan Materials and Forms

 

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Health Net Medicare Advantage for Oregon and Washington member ID card for your plan number and type to view materials for your plan. 

  • View a sample of an Health Net Member ID Card to see where this information is located.

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Health Net Medicare Advantage for Oregon and Washington ID card or have questions about plan materials, give us a call. We’re here to help.

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