Effective September 1, 2023, Kaiser Permanente will be using a new group termination form for all small and large commercial groups in the Mid-Atlantic States Region.

While we never want to see our groups leave Kaiser Permanente, when it happens, the new form will help ensure all information needed for termination is captured. The processing time is accelerated and with greater accuracy. Additional data will also help inform our teams of the reasons groups are leaving Kaiser Permanente. This enables us to improve our services and support for members and groups in the future.

The termination form will be offered as a web-based form for easy submission.

Brokers working with a group that requests to terminate Kaiser Permanente coverage can reach out to their Account Manager to request the link to the form. The link will be provided to you and the Employer Group. The Employer Group must complete and sign the form.

Once completed, forms are automatically submitted to your Account Management team for processing.

This termination form process will begin in the Mid-Atlantic States Region and become effective in other Kaiser Permanente regions in the future.

If you have any questions, please reach out to your Account Management Representative.