Resources / Materials
Quiz
Los Angeles
- Quiz - English (pdf)
- Quiz - Spanish - Español (pdf)
- Quiz - Armenian - Հայերեն (pdf)
- Quiz - Cambodian - ខ្មែរ (pdf)
- Quiz - Chinese - 中文 (pdf)
- Quiz - Hmong - Hmoob (pdf)
- Quiz - Korean - 한국어 (pdf)
- Quiz - Russian - Русский (pdf)
- Quiz - Vietnamese - Tiếng Việt (pdf)
Fact Sheet
Los Angeles
- Fact Sheet - English (pdf)
- Fact Sheet - Spanish - Español (pdf)
- Fact Sheet - Armenian - Հայերեն (pdf)
- Fact Sheet - Cambodian - ខ្មែរ (pdf)
- Fact Sheet - Chinese - 中文 (pdf)
- Fact Sheet - Hmong - Hmoob (pdf)
- Fact Sheet - Korean - 한국어 (pdf)
- Fact Sheet - Russian - Русский (pdf)
- Fact Sheet - Vietnamese - Tiếng Việt (pdf)
Checklist
Los Angeles
- Checklist - English (pdf)
- Checklist - Spanish - Español (pdf)
- Checklist - Armenian - Հայերեն (pdf)
- Checklist - Cambodian - ខ្មែរ (pdf)
- Checklist - Chinese - 中文 (pdf)
- Checklist - Hmong - Hmoob (pdf)
- Checklist - Korean - 한국어 (pdf)
- Checklist - Russian - Русский (pdf)
- Checklist - Vietnamese - Tiếng Việt (pdf)
Benefit Highlights
Los Angeles
- Benefit Highlights - English (pdf)
- Benefit Highlights - Spanish - Español (pdf)
- Benefit Highlights - Armenian - Հայերեն (pdf)
- Benefit Highlights - Cambodian - ខ្មែរ (pdf)
- Benefit Highlights - Chinese - 中文 (pdf)
- Benefit Highlights - Hmong - Hmoob (pdf)
- Benefit Highlights - Korean - 한국어 (pdf)
- Benefit Highlights - Russian - Русский (pdf)
- Benefit Highlights - Vietnamese - Tiếng Việt (pdf)
Care Coordination
Los Angeles
- Care Coordination - English (pdf)
- Care Coordination - Spanish - Español (pdf)
- Care Coordination - Armenian - Հայերեն (pdf)
- Care Coordination - Cambodian - ខ្មែរ (pdf)
- Care Coordination - Chinese - 中文 (pdf)
- Care Coordination - Hmong - Hmoob (pdf)
- Care Coordination - Korean - 한국어 (pdf)
- Care Coordination - Russian - Русский (pdf)
- Care Coordination - Vietnamese - Tiếng Việt (pdf)
Los Angeles Directories
- Provider & Pharmacy Directory Vol. 1 - Los Angeles County, CA Region: Antelope Valley; San Fernando Valley (less burbank and Glendale) - English (PDF)
- Provider & Pharmacy Directory Vol. 2 - Los Angeles County, CA Region: Burbank, Glendale - English (PDF)
- Provider & Pharmacy Directory Vol. 3 - Los Angeles County, CA Region: San Gabriel Valley (South / West) - English (PDF)
- Provider & Pharmacy Directory Vol. 4 - Los Angeles County, CA Region: San Gabriel Valley (North / East) - English (PDF)
- Provider & Pharmacy Directory Vol. 5 - Los Angeles County, CA Region: Metro (North / East) - English (PDF)
- Provider & Pharmacy Directory Vol. 6 - Los Angeles County, CA Region: Metro (South / West) - English (PDF)
- Provider & Pharmacy Directory Vol. 7 - Los Angeles County, CA Region: West and South LA - English (PDF)
- Provider & Pharmacy Directory Vol. 8 - Los Angeles County, CA Region: East LA (West) - English (PDF)
- Provider & Pharmacy Directory Vol. 9 - Los Angeles County, CA Region: East LA (East) - English (PDF)
- Provider & Pharmacy Directory Vol. 10 - Los Angeles County, CA Region: South Bay - English (PDF)
San Diego Directories
Need Help Finding a Health Net Cal MediConnect Plan Doctor or Pharmacy?
For Los Angeles and San Diego
Member Guide - find out how to have a hard copy Provider/Pharmacy directory mailed directly to you by selecting your language below:
- Ways to Access the Directories - English (PDF)
- Ways to Access the Directories - Spanish - Español (PDF)
- Ways to Access the Directories - Arabic - العربية (PDF)
- Ways to Access the Directories - Armenian - Հայերեն (PDF)
- Ways to Access the Directories - Chinese Mandarin - 中文 (PDF)
- Ways to Access the Directories - Cambodian - ខ្មែរ (PDF)
- Ways to Access the Directories - Farsi/Persian - فارسی (PDF)
- Ways to Access the Directories - Korean - 한국어 (PDF)
- Ways to Access the Directories - Russian - Русский (PDF)
- Ways to Access the Directories - Tagalog (PDF)
- Ways to Access the Directories - Vietnamese - Tiếng Việt (PDF)
Over the Counter Benefits
- Over the Counter Benefits - English (PDF)
- Over the Counter Benefits - Spanish - Español (PDF)
- Over the Counter Benefits - Arabic - العربية (PDF)
- Over the Counter Benefits - Armenian - Հայերեն (PDF)
- Over the Counter Benefits - Chinese Mandarin - 中文 (PDF)
- Over the Counter Benefits - Cambodian - ខ្មែរ (PDF)
- Over the Counter Benefits - Farsi/Persian - فارسی (PDF)
- Over the Counter Benefits - Korean - 한국어 (PDF)
- Over the Counter Benefits - Russian - Русский (PDF)
- Over the Counter Benefits - Tagalog (PDF)
- Over the Counter Benefits - Vietnamese - Tiếng Việt (PDF)
As a member of the Health Net Cal MediConnect Plan (Medicare-Medicaid Plan), you can order select Over-the-Counter (OTC) health supplies by mail at no extra cost to you.
National Coverage Determination Notice
- National Coverage Determination Notice - English (PDF)
- National Coverage Determination Notice - Spanish - Español (PDF)
- National Coverage Determination Notice - Arabic - العربية (PDF)
- National Coverage Determination Notice - Armenian - Հայերեն (PDF)
- National Coverage Determination Notice - Chinese Mandarin - 中文 (PDF)
- National Coverage Determination Notice - Cambodian - ខ្មែរ (PDF)
- National Coverage Determination Notice - Farsi/Persian - فارسی (PDF)
- National Coverage Determination Notice - Korean - 한국어 (PDF)
- National Coverage Determination Notice - Russian - Русский (PDF)
- National Coverage Determination Notice - Tagalog (PDF)
- National Coverage Determination Notice - Vietnamese - Tiếng Việt (PDF)
Multi-Language Insert & Nondiscrimination Notice
Los Angeles and San Diego
- List of Drugs - English (PDF)
- List of Drugs -Spanish - Español (PDF)
- List of Drugs - Arabic - العربية (PDF)
- List of Drugs - Armenian - Հայերեն (PDF)
- List of Drugs - Chinese Mandarin - 中文 (PDF)
- List of Drugs - Cambodian - ខ្មែរ (PDF)
- List of Drugs - Farsi/Persian - فارسی (PDF)
- List of Drugs - Korean - 한국어 (PDF)
- List of Drugs - Russian - Русский (PDF)
- List of Drugs - Tagalog (PDF)
- List of Drugs - Vietnamese - Tiếng Việt (PDF)
Annual Notice of Changes (ANOC)
Los Angeles
- Los Angeles ANOC - English (pdf)
- Los Angeles ANOC - Spanish - Español (pdf)
- Los Angeles ANOC - Arabic - العربية (pdf)
- Los Angeles ANOC - Armenian - Հայերեն (pdf)
- Los Angeles ANOC - Cambodian - ខ្មែរ (pdf)
- Los Angeles ANOC - Chinese Mandarin - 中文 (pdf)
- Los Angeles ANOC - Farsi/Persian - فارسی (pdf)
- Los Angeles ANOC – Korean - 한국어 (pdf)
- Los Angeles ANOC - Russian - Русский (pdf)
- Los Angeles ANOC - Tagalog (pdf)
- Los Angeles ANOC - Vietnamese - Tiếng Việt (pdf)
San Diego
- San Diego ANOC - English (pdf)
- San Diego ANOC - Spanish - Español (pdf)
- San Diego ANOC - Arabic - العربية (pdf)
- San Diego ANOC - Tagalog (pdf)
- San Diego ANOC - Vietnamese - Tiếng Việt (pdf)
Member Handbook
Los Angeles
- Los Angeles Member Handbook - English (pdf)
- Los Angeles Member Handbook - Spanish - Español (pdf)
- Los Angeles Member Handbook - Arabic - العربية (pdf)
- Los Angeles Member Handbook – Armenian - Հայերեն (pdf)
- Los Angeles Member Handbook - Cambodian - ខ្មែរ (pdf)
- Los Angeles Member Handbook – Chinese Mandarin - 中文 (pdf)
- Los Angeles Member Handbook – Farsi/Persian - فارسی (pdf)
- Los Angeles Member Handbook – Korean - 한국어 (pdf)
- Los Angeles Member Handbook – Russian - Русский (pdf)
- Los Angeles Member Handbook - Tagalog (pdf)
- Los Angeles Member Handbook - Vietnamese - Tiếng Việt (pdf)
San Diego
Los Angeles
- Los Angeles Summary of Benefits - English (pdf)
- Los Angeles Summary of Benefits - Spanish - Español (pdf)
- Los Angeles Summary of Benefits - Arabic - العربية (pdf)
- Los Angeles Summary of Benefits - Armenian - Հայերեն (pdf)
- Los Angeles Summary of Benefits - Cambodian - ខ្មែរ (pdf)
- Los Angeles Summary of Benefits - Chinese Mandarin - 中文 (pdf)
- Los Angeles Summary of Benefits - Farsi/Persian - فارسی (pdf)
- Los Angeles Summary of Benefits - Korean - 한국어 (pdf)
- Los Angeles Summary of Benefits - Russian - Русский (pdf)
- Los Angeles Summary of Benefits - Tagalog (pdf)
- Los Angeles Summary of Benefits - Vietnamese - Tiếng Việt (pdf)
San Diego
Transition of Care Form
Scope of Appointment
Notice of Privacy Practices
- Notice of Privacy Practices - English (pdf)
- Notice of Privacy Practices - Spanish - Español (pdf)
- Notice of Privacy Practices - Arabic - العربية (pdf)
- Notice of Privacy Practices - Armenian - Հայերեն (pdf)
- Notice of Privacy Practices - Cambodian - ខ្មែរ (pdf)
- Notice of Privacy Practices - Chinese Mandarin - 中文 (pdf)
- Notice of Privacy Practices - Farsi/Persian - فارسی (pdf)
- Notice of Privacy Practices - Korean - 한국어 (pdf)
- Notice of Privacy Practices - Russian - Русский (pdf)
- Notice of Privacy Practices - Tagalog (pdf)
- Notice of Privacy Practices - Vietnamese - Tiếng Việt (pdf)
Authorization to Disclose Protected Health Information
- Authorization to Disclose Protected Health Information - English (pdf)
- Authorization to Disclose Protected Health Information - Spanish - Español (pdf)
- Authorization to Disclose Protected Health Information - Arabic - العربية (pdf)
- Authorization to Disclose Protected Health Information - Armenian - Հայերեն (pdf)
- Authorization to Disclose Protected Health Information - Cambodian - ខ្មែរ (pdf)
- Authorization to Disclose Protected Health Information - Chinese Mandarin - 中文 (pdf)
- Authorization to Disclose Protected Health Information - Farsi/Persian - فارسی (pdf)
- Authorization to Disclose Protected Health Information - Korean - 한국어 (pdf)
- Authorization to Disclose Protected Health Information - Russian - Русский (pdf)
- Authorization to Disclose Protected Health Information - Tagalog (pdf)
- Authorization to Disclose Protected Health Information - Vietnamese - Tiếng Việt (pdf)
Confidential Communication Request
- Confidential Communication Request - Spanish - Español (pdf)
- Confidential Communication Request - Arabic - العربية (pdf)
- Confidential Communication Request - Armenian - Հայերեն (pdf)
- Confidential Communication Request - Cambodian - ខ្មែរ (pdf)
- Confidential Communication Request - Chinese Mandarin - 中文 (pdf)
- Confidential Communication Request - Farsi/Persian - فارسی (pdf)
- Confidential Communication Request - Korean - 한국어 (pdf)
- Confidential Communication Request - Russian - Русский (pdf)
- Confidential Communication Request - Tagalog (pdf)
- Confidential Communication Request - Vietnamese - Tiếng Việt (pdf)
Mail Order Pharmacy
Medication Therapy Management
Over-the-Counter Benefits
Prescription Claims
Los Angeles
- Los Angeles ANOC - English (PDF)
- Los Angeles ANOC - Español (PDF)
- Los Angeles ANOC - Arabic العربية (PDF)
- Los Angeles ANOC - Armenian Հայերեն (PDF)
- Los Angeles ANOC - Cambodian ខ្មែរ (PDF)
- Los Angeles ANOC - Chinese Mandarin 中文 (PDF)
- Los Angeles ANOC - Farsi/Persian فارسی (PDF)
- Los Angeles ANOC – Korean 한국어 (PDF)
- Los Angeles ANOC - Russian Русский язык (PDF)
- Los Angeles ANOC - Tagalog (PDF)
- Los Angeles ANOC - Vietnamese Tiếng Việt (PDF)
San Diego
Information last updated: 07/11/2018
H3237_18_Website_Approved_08172018