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Individual and Family

Individual and Family forms and materials

View, download, and print commonly used forms.

Review the 2026 GA KPIF Broker Training Guide (PDF) to get the updates you need for 2026 Open Enrollment, including plan and product updates, an overview of KPIF sales tools and enhancements, compensation details and more.

Enrollment and plan change materials below are in market on November 1, 2025, for January 1, 2026 effective dates.

Effective March 6, 2026, Kaiser Permanente will allow new enrollments or existing member plan changes only into the following KPIF GA plans for 2026 plan selection:o  

  • Silver HMO $5000 $40 Virtual Complete (GA and Signature)
  • Silver HMO $6000 $50 (GA and Signature)
  • Gold HMO $500 $20 (GA and Signature)

Application

KPIF Application

SEP

KPIF Special Enrollment Period Guide
KPIF Special Enrollment Triggering Period Proof of Triggering Event Form

Enrollment Guide and Rates

KPIF Enrollment Guide
KPIF Rates

Small Business

View, download, and print commonly used forms.

Employer Forms

Consolidated Appropriations Act and Transparency in Coverage LOA
Small Group List Enrollment

For new business only

Small Group Employer Application
Small Group 1099 Validation Form
Small Group PEO Verification Form
Small Group Electronic Transfer for Initial and Recurring Payment
Small Group Employees Confirmation Form
Small Group Account Change Form

Employee Forms

Small Group Employee Enrollment Form (Existing Group)

Use our new electronic signature form – completed documents will route directly to KP for processing

Waiver of Coverage

Broker Support Forms

Small Group Sold Group Checklist
Small Group Underwriting Guidelines
Small Group Termination Form
Employee Assistance Program (EAP) from TELUS Health:

Large Business

Mid & Large business

View, download, and print commonly used forms.

Before You Get Started
Before completing the form, please take a few minutes to gather the information below. Having this information ready will help ensure your form is completed accurately and processed without delay.

Information you’ll need from your Employer/HR Representative or Broker:

  • Group ID
  • Subgroup ID
  • Subgroup Name
  • Effective date of the enrollment or change

If you are unsure of any of this information, contact your Employer/HR representative or Broker before starting the form.

Enrollment Forms

Mid Group Employee Enrollment Form with Medical Review (51-99 Employees)
Large Group Employer Application
Large Group Employee Enrollment & Change Form

Other Forms and Support

Consolidated Appropriations Act and Transparency in Coverage LOA
Employee Assistance Program (EAP) from TELUS Health: