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This document provides information about the optional supplemental benefits available through Health Net Medicare Advantage Plans for 2011, including Gold Options for dental, vision, acupuncture,
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How to fill out 2011 HEALTH NET MEDICARE ADVANTAGE PLANS OPTIONAL SUPPLEMENTAL BENEFITS – GOLD benefits INDIVIDUAL ENROLLMENT FORM

01
Obtain the 2011 Health Net Medicare Advantage Plans Optional Supplemental Benefits – Gold Benefits Individual Enrollment Form from the official website or local office.
02
Read the instructions carefully on the first page to understand the requirements.
03
Complete the personal information section, including your name, address, date of birth, and Medicare number.
04
Provide information about your current health plan and any other insurance coverage you may have.
05
Indicate your choice for optional supplemental benefits by checking the appropriate boxes related to your needs.
06
Fill out the payment information section if applicable, including your bank details or preferred payment method.
07
Sign and date the form to certify that all information provided is accurate.
08
Review the completed form for any errors or omissions.
09
Submit the form via mail or online as instructed, ensuring it is sent to the correct address.
10
Keep a copy of the completed form for your records.

Who needs 2011 HEALTH NET MEDICARE ADVANTAGE PLANS OPTIONAL SUPPLEMENTAL BENEFITS – GOLD benefits INDIVIDUAL ENROLLMENT FORM?

01
Individuals who are enrolled in Medicare and are looking for additional supplemental benefits.
02
Seniors who want to enhance their health coverage beyond standard Medicare offerings.
03
People who have specific health needs that could be met by the optional supplemental benefits.
04
Individuals seeking financial assistance to cover costs not included in their primary Medicare plan.
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Both Health Net and Blue Shield are in the top 5 carriers in California now. They have both experienced significant changes in how they operate over the past decade. More importantly, both can be priced really well in the three different California markets: Individual and Family (including Covered California)
Welcome to Wellcare By Health Net's new Medicare Advantage website. We are simplifying Medicare so you can choose and use an affordable local plan that will help you achieve your best possible health.

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The 2011 Health Net Medicare Advantage Plans Optional Supplemental Benefits – Gold benefits Individual Enrollment Form is a document used by individuals to enroll in additional supplemental insurance benefits that may enhance their Medicare coverage, providing services that are not fully covered by standard Medicare plans.
Individuals who wish to enroll in the optional supplemental benefits associated with the Health Net Medicare Advantage Plans are required to file the Individual Enrollment Form.
To fill out the form, individuals must provide their personal information such as name, address, date of birth, Medicare number, and select the desired supplemental benefits they wish to enroll in. It is important to follow the instructions on the form carefully to ensure all required fields are completed.
The purpose of the form is to enable eligible individuals to formally request enrollment in the optional supplemental benefits offered by Health Net Medicare Advantage plans, which can help cover gaps in standard Medicare coverage.
The information that must be reported includes personal details like the applicant's name, address, phone number, date of birth, Medicare number, as well as the specifics of the optional benefits being requested.
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