Individuals and families (KPIF)

Accessing the right forms for your clients is easy. Below are commonly used forms for the KPIF line of business. 

Employee Forms

Kaiser Permanente Individual and Family quotes and enrolling

We offer tools and resources to help you advise your clients on the right individual and family plan, whether you're selling through the exchange or directly from Kaiser Permanente. Visit buykp.org, Kaiser Permanente’s online quoting tool, to compare on- and off-exchange plans, see if your client may be eligible for a subsidy, and get a fast quote.

Once your client is ready, you can submit an application for new enrollment in one of the following ways.

  • On exchange: Visit the Washington Healthplanfinder website to submit your client’s application.
  • Off exchange: Use the Sign Me Up (SMU) tool to submit your client’s application.
    1. If you're a first-time user, register for a broker account. See training resources below.
    2. Sign in to your account, and from your dashboard you can create a new quote, create a personalized landing page to send to your client to start the online application, or download a paper application if your client prefers that method. Your Kaiser Permanente agent number is automatically tied to the downloaded SMU application, and you will be set up as the producer of record.
      • If your client prefers a paper application, fax or mail it to the number or address below. Please return every page of the application, completed, with all the required signatures, and proof of your qualifying life event (if required). To ensure you are set up as the Producer of Record, complete page 8 of the application.

      Kaiser Foundation Health Plan of Washington
      Membership Administration
      P.O. Box 23127
      San Diego, CA 92193-9921

      Or send it by secure fax to: 1-855-355-5334.

    3. Track your client’s online application status using the SMU tool, which gives you more visibility into the process.

Get to know the Sign Me Up tool

Learn how to use the Kaiser Permanente Washington SMU tool with the training videos and resources below.

KPIF Enrollment Guide
KPIF Enrollment Application
Pediatric Dental Attestation

2025 English (PDF) | 2025 Español (PDF)

Proof of Qualifying Life Event Form
Special Enrollment Guide
Cost Share and Plan Mapping Document
KPIF Monthly Rates
Account Change Form
Dental Plans Summary of Benefits
Individual and Family Service Area Map
Single Page Summaries

Forms & Documents for Existing Employer Groups

Other Forms and Support

Large Business

Build a healthier future for your organization

At Kaiser Permanente, we know your organization has unique needs. That's why we offer a variety of provider networks, benefit options, and services for you to choose from. Whether you are looking for the quality and value of our Core plan or more provider choice with a PPO plan, you'll have access to our high-performing health system.1

Washington Permanente Medical Group is the highest-ranked medical group in the state for quality of care, and among the highest-ranked for lower cost of care.2

Recognized with 17 awards for best practices by the Bree Collaborative Trailblazer awards in 2024.3

Employee Forms

Employee Enrollment and Change Form

English (PDF) | Español (PDF) – Coming soon

Group Employee Enrollment Change Form Dental

English (PDF)

Group Master Application

English (PDF) | Español (PDF) – Coming soon

Forms & Documents for Existing Employer Groups

Employer includes the forms and documents as Producer.

2026 Large Group Complete Suite Plan Comparison

This interactive PDF is an overview of our 2026 Complete Suite portfolio and is created to easily explore a wide range of Kaiser Permanente plans. It also enables you to get quick side-by-side comparisons of the different plans we have to offer.

English (PDF)

2026 Large Group Complete Suite Brochure

Your guide to large group plans and products with Kaiser Permanente. This document features content outlining the Large Group plans for 2026. Also includes value prop information such as value-added services for members and employers.

English (PDF)

2025 Large Group Complete Suite Plan Comparison

This interactive PDF is an overview of our 2025 Complete Suite portfolio and is created to easily explore a wide range of Kaiser Permanente plans. It also enables you to get quick side-by-side comparisons of the different plans we have to offer.

English (PDF)

2025 Large Group Complete Suite Brochure

Your guide to large group plans and products with Kaiser Permanente. This document features content outlining the Large Group plans for 2025. Also includes value prop information such as value-added services for members and employers.

English (PDF)

Employee Fitness B2B Sell Sheet

Employee fitness and well-being support from Optum. Memberships and services to boost healthier lifestyles.

English (PDF)

Health360 B2B Flyer

B2B flyer explaining the features and benefits of Health360, KPWA's bundled plan with Delta Dental of Washington.

English (PDF)

KP Plus B2B Sell Sheet

English (PDF)

Virtual Complete FAQ

English (PDF)

Virtual Complete Sell Sheet

English (PDF)

Other Forms and Support

2026 Open Enrollment Guide

English (PDF) | Español (PDF)

2025 Open Enrollment Guide

English (PDF)

Access PPO Network Flyer

English (PDF) | Español (PDF)

Access PPO Travel Flyer

English (PDF) | Español (PDF)

Core HMO Network Flyer

English (PDF) | Español (PDF)

Core Travel Flyer

English (PDF) | Español (PDF)

Digital Self Care Apps Flyer

English (PDF)

Health360 B2C Flyer

B2C flyer for the One Pass Select Affinity from Optum fitness program.

English (PDF)

Healthy Resources Guide

Resource for KPWA members that outlines our online tools, wellness support and resources.

English (PDF)

KP.org and Mobile App Flyer

English (PDF)

MOB Fitness Flyer B2C

English (PDF)

New Member and Care Transition Flyer
Options Network Flyer

English (PDF) | Español (PDF)

Summit PPO Network Flyer

English (PDF) | Español (PDF)

Summit PPO Travel Flyer

English (PDF) | Español (PDF)

Virtual Complete OE Flyer

English (PDF)

Virtual Plus B2C Overview

English (PDF)

Virtual Plus Enrollment Guide

English (PDF)

1 Criteria established by American Medical Group Association
2 Washington Health Alliance 2024 Community Checkup report.
3 Bree Collaborative Awards, accessed February 28, 2024.

Small Business

Resources to support your clients for a smooth enrollment process. 

Employee Forms 2026

2026 Employee Enrollment and Change Form

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

English (PDF) | Espanol (PDF) – Coming soon

2026 Enrollment Guide

English (PDF) | Espanol (PDF)

2026 Underwriting Guidelines

English (PDF)

Administrator Guide

English (PDF)

Compare your Options Plan Brochure

English (PDF)

Core HMO Network flyer

English (PDF)

Deductible & Out of Pocket Crediting form

English (PDF)

Employer Attestation - Decline Coverage form

English (PDF) | Español (PDF)

Employee Attestation

English (PDF)

KP Plus B2B Sell Sheet

English (PDF)

Quote Request form

English (PDF)

2026 Group Master Application

English (PDF)

Small Group Rating Areas

English (PDF)

Small Group Enrollment Census Template

English (Excel)

Disclosure Document

English (PDF)

Medicare Creditable Coverage

English (PDF)

2026 Dental Rate Flyer

English (PDF)

Employee Forms 2025

2025 Employee Enrollment and Change Form

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

English (PDF) | Espanol (PDF)

2025 Underwriting Guidelines

English (PDF)

Administrator Guide

English (PDF)

Compare your Options Plan Brochure

English (PDF)

Core HMO Network flyer

English (PDF)

Deductible & Out of Pocket Crediting form

English (PDF)

Employer Attestation - Decline Coverage form

English (PDF) | Español (PDF)

KP Plus B2B Sell Sheet

English (PDF)

Quote Request form

English (PDF)

2025 Group Master Application

English (PDF)

Small Group Rating Areas

English (PDF)

Small Group Enrollment Census Template

English (Excel)

Disclosure Document

English (PDF)

Other Forms and Support

2026 Employer includes the forms and documents as Producer.

2026 Dental Rate Flyer

Coming soon

2026 Pediatric Dental Plan Flyer

English (PDF)

2026 Adult/Pediatric Dental Plan Summary (Basic) Flyer

English (PDF)

2026 Adult/Pediatric Dental Plan Summary (Standard) Flyer

English (PDF)

2026 Cost Share and Plan mapping Flyer

English (PDF)

Sales Kit Checklist Flyer

English (PDF)

Access PPO Network Flyer

English (PDF) | Español (PDF)

Access PPO Travel Flyer

English (PDF) | Español (PDF)

Options Network Flyer

English (PDF) | Español (PDF)

Core Network Flyer

English (PDF) | Español (PDF)

Core Network Travel Flyer

English (PDF) | Español (PDF)

Summit PPO Network Flyer

English (PDF) | Español (PDF)

Summit PPO Network Travel Flyer

English (PDF) | Español (PDF)

HMO, KP Plus and Access PPO Service Area Map

English (PDF)

Other Forms and Support

2025 Dental Rate Flyer

English (PDF)

2025 Pediatric Dental Plan Flyer

English (PDF)

2025 Adult/Pediatric Dental Plan Summary (Standard/Basic) Flyer

English (PDF)

Cost Share and Plan mapping Flyer

English (PDF)

2025 Sales Kit Checklist Flyer

English (PDF)

Access PPO Network Flyer

English (PDF) | Español (PDF)

Access PPO Travel Flyer

English (PDF) | Español (PDF)

Options Network Flyer

English (PDF) | Español (PDF)

Core Network Flyer

English (PDF) | Español (PDF)

Summit PPO Network Flyer

English (PDF) | Español (PDF)

Summit PPO Network Travel Flyer

English (PDF) | Español (PDF)

HMO, KP Plus and Access PPO Service Area Map

English (PDF)

Medicare Advantage

Our high quality Medicare Advantage (HMO) health plans combine both care and coverage. As a care provider and a health plan, we work to ensure our mutual clients have the best experience, both as plan members and as patients.

Kaiser Foundation Health Plan of Washington offers individual Medicare Advantage (HMO) plans in the following Washington state counties: Island, King, Kitsap, Lewis, Pierce, Skagit, Snohomish, Spokane, Thurston, Whatcom and partial counties Grays Harbor and Mason.1

1 Grays Harbor County service area ZIP codes: 98541, 98557, 98559, 98568. Mason County service area ZIP codes: 98524, 98528, 98546, 98548, 98555, 98584, 98588, 98592.

Employee Forms

2026 Medicare Advantage Enrollment Form

English (PDF)

2026 Evidence of Coverage Basic MA

English (PDF)

2026 Evidence of Coverage MAPD

English (PDF)

2026 Pre Enrollment Checklist

English (PDF)

Scope of Appointment

English (PDF)

2026 Summary of Benefits Optimal

English (PDF)

2026 Summary of Benefits Centennial Columbia

English (PDF)

2026 Summary Of Benefits Anchor Harbor Key

English (PDF)

2026 Summary Of Benefits Essential Key (Kin, Pie. Sno. Thu.)

English (PDF)

2026 Summary Of Benefits Essential Vital Sound (Kit. Gra. Lew. Mas.)

English (PDF)

Other Forms and Support

2026 Advantage Plus Brochure

English (PDF)

2026 Service Area Reduction/Non-Renewal Letter

English (PDF)

2026 Annual Notice Of Changes Anchor

English (PDF)

2026 Annual Notice Of Changes Basic

English (PDF)

2026 Annual Notice Of Changes Centennial

English (PDF)

2026 Annual Notice Of Changes Columbia

English (PDF) 

2026 Annual Notice Of Changes Essential

English (PDF)

2026 Annual Notice Of Changes Harbor

English (PDF)

2026 Annual Notice Of Changes Key

English (PDF)

2026 Annual Notice Of Changes Optimal

English (PDF)

Guide to Medicare

English (PDF)

2026 Service Area Map

English (PDF)

2026 Star Rating

English (PDF)