Health Net Recertification Clarification

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PRISM - Health Net is Now Available Through Claremont!

Why Choose Health Net?
✔ Lowest rates in the market – Affordable options without compromising quality.
✔ Robust PPO network – Competes with major carriers like Anthem and Blue Shield.
✔ Flexible HMO options – Networks to fit nearly every group statewide and every budget.
✔ Simplified underwriting – Only 25% participation required for groups with 5+ enrolling. No DE9C or prior carrier bill needed.
✔ Easy-to-sell benefits – $0 deductible HMO plans + four years of rate stability.
✔ Nationwide coverage – Cigna network access for out-of-state employees + state plurality rules for group qualification.

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Need guidance on networks, plan designs, or have questions? We’re here to help!

Call us at 800.696.4543 | Email us at info@claremontcompanies.com.

Jul 14, 2026, 2 Minute Read

Claremont wants to flag a point of clarification from Health Net for brokers with single-enrolled groups going through recertification.

The requirement, clarified: For groups where only the owner is currently enrolled, Health Net requires that the group have at least one eligible W-2 employee — someone who is not an owner or spouse of an owner. That employee does not need to enroll in coverage to satisfy the requirement; they simply need to be eligible and on payroll. A group where the owner is the only enrolled participant can remain qualified for small group coverage as long as this condition is met.

Why we’re sharing this: Some recent recertification notices used language that could be read as requiring the eligible employee to enroll, rather than simply exist. Health Net has confirmed the correct standard and is updating notice language going forward to reduce confusion.

What this means for your groups: If a client receives a recertification notice, there’s no need to enroll an additional employee to maintain eligibility — just confirm they have at least one eligible W-2 employee who isn’t an owner or spouse of an owner on payroll.

Why Brokers Choose Health Net? Flexibility that fits most clients:

Enhanced Choice — 4+ Enrolling Employees

Mix and match any HMO and PPO plans — no network restrictions
No DE9C, payroll records, prior carrier bill, or ownership documents required
No waivers needed for groups with 10 or more enrolled
4–9 enrolled: only 25% participation required (employees on another carrier don’t count against the threshold)
10+ enrolled: zero participation requirement, no waivers when not paired with Life or Employer-paid Dental/Vision

Flexible Underwriting — Startups & PEOs

Works for startups of any size — even groups of one — with just two weeks of payroll
Mix and match from all 61 Health Net plans
Can be written alongside any carrier, with no limit on the number of carriers as long as participation is met
Groups of 1–3 enrolling require 70% participation; PEO subgroups accepted with a quarterly wage report or two weeks of payroll
Household employers accepted with a DE9C or DE-1HW

Health Net covers a wide range of group situations — from lean startups to established employers with complex carrier arrangements. If you have a group that’s been tough to place, it’s worth the conversation.

Questions? Reach out to your Claremont team for a full Health Net overview and quoting support.

Health Net Advantages

Attractive rates – Affordable plans without sacrificing quality.
Robust PPO network – Competes directly with major carriers like Anthem and Blue Shield.
$0 HMO plans – Broad statewide access tailored to fit any group or budget.
Simplified underwriting – Works alongside other carriers, with only 25% participation required for groups with 4+ enrolling. No DE9C or prior carrier bill needed.
Easy-to-sell benefits – $0 deductible HMO plans, choose from 61 plan options, and five years of rate stability.
Nationwide coverage – Cigna network access for out-of-state employees and state plurality rules for group qualification.

Learn more about Health Net’s versatile health plans, ancillary coverage, wellness programs, and value-added services.

Contact us today for a Health Net quote.

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Questions?
Contact The Answer Team at 800.696.4543 or info@claremontcompanies.com.