Account Services | Forms  
Account Services | Forms
Below are the Health Net Dental and Vision forms available for download in PDF format. Adobe Acrobat reader is required to view these files, if you do not have this application, please follow this link to Adobe for your free version.

When completing and submitting downloaded forms be sure to send us the signed originals and retain a copy for your records.

Health Net Dental HMO plans provided by Safeguard. Health Plans, Inc. (Safeguard). Health Net Dental PPO policies are underwritten by Safehealth Life Insurance Company (Safehealth). Health Net Vision PPO plans are underwritten by Fedlity Security Life Insurance Compay and serviced by EyeMed Vision Care, LLC (together, the "Fidelity Entities"). Discounts on vision care service and products are made available by EyeMed. Obligations of Safeguard, Safehealth and the Fidelity Entities are not the obligations of nor guaranteed by Health Net, Inc. or its affiliates.