Small Business
Forms & Documents for Existing Employer Groups
Consolidated Appropriations Act and Transparency in Coverage LOA
Maryland small group employer application - 2025
Virginia small group employer application - 2025
2024
Maryland small group employer application - 2024
Virginia small group employer application - 2024
Employee Forms
2025
Small group employee application - 2025 (Existing Group)
Use our new electronic signature form – completed documents will route directly to KP for processing
2024
Small group employee application - 2024
Use our new electronic signature form – completed documents will route directly to KP for processing
Other Forms and Support
Electronic Funds Transfer (ACH) Form for small groups
Kaiser Employee Enrollment Ledger (KEEL)
Incapacitated dependent form
Declination of coverage
Payroll attestation
2025 Broker Authorization Form (Maryland)
Broker Authorization Form (Maryland)
2025 Broker Authorization Form (Virginia)
Broker Authorization Form (Virginia)
2025 Dental Election Form (Maryland-Virginia)
Dental Election Form (Maryland-Virginia)
Dental Election Form (Maryland)
Dental Election Form (Virginia)
Employee Assistance Program (EAP) from TELUS Health:
Large Business
Forms & Documents for Existing Employer Groups
2025
DC, MD, and VA MID/LARGE employer application for groups of 51 or more employees
English (PDF)
Risk questionnaire must be completed along with the DC, MD, and VA MID/LARGE employer application
English (PDF)
2024
DC, MD, and VA MID/LARGE employer application for groups of 51 or more employees
English (PDF)
Employee Forms
2025
DC, MD, and VA MID/LARGE employee enrollment and change form for groups of 51 or more employees
English (PDF) | Español (PDF)
2024
DC, MD, and VA MID/LARGE employee enrollment and change form for groups of 51 or more employees
English (PDF) | Español (PDF)
Other Forms and Support
Consolidated Appropriations Act and Transparency in Coverage LOA
Employee Assistance Program (EAP) from TELUS Health:
- EAP Group Contract (Order Form)
- EAP Group Amending Agreement
- TELUS Health EAP Launch Packet Toolkit
- EAP with TELUS Evidence of Coverage
Individual and Family
Review the 2025 MAS KPIF Broker Training Guide (PDF) to get the updates you need for 2025 Open Enrollment, including plan and product updates, an overview of KPIF sales tools and enhancements, compensation details and more.
Review the KPIF Broker Frequently Asked Questions below for answers to common questions about selling Kaiser Permanente for Individual and Family Plans (KPIF) and working with KP.
Enrollment and plan change materials below are in market on November 1, 2024, for January 1, 2025 effective dates.