Health Net 2011 Annual Report Download - page 267

IRREVOCABLE PROXY
I, the undersigned, hereby irrevocably authorize and empower [ ], the [ ] of Health Net, Inc. (the
“Company”), and [ ], the [ ] of the Company, or each of their successors in the event either of them is no
longer serving the Company in such capacity, (collectively, the “Proxies”) to represent me with respect to any and all shares of
Restricted Stock (as such term is defined in the Restricted Stock Agreement (the “Restricted Stock Agreement”) by and between the
Company and the undersigned) that are not yet vested, at any and all general meetings of the shareholders of the Company.
The Proxies are irrevocably authorized and empowered to receive, in my stead, any and all notices of and invitations to the
Company’s general meetings, and to participate in all such general meetings; and the Proxies are authorized and empowered to vote
all such unvested shares in such manner as the Proxies shall, in their sole discretion, deem to be in the best interests of the Company.
This proxy shall remain in full force and effect until the shares of Restricted Stock granted to me pursuant to the Restricted
Stock Agreement have vested in accordance with the terms of the Restricted Stock Agreement, unless otherwise determined by the
Company in writing.
NAME:
DATE:
SIGNATURE: