Georgia

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.

Application

KPIF Application

2026 English (PDF) | 2026 Español (PDF) | 2025 English (PDF) | 2025 Español (PDF)

Account Change Form

Effective January 16, 2026, Kaiser Permanente will not allow new enrollments or current member plan changes into any KPIF GA Off Exchange plans. Please visit GeorgiaAccess.gov for available coverage options.

Current KPIF GA members can add new dependents to their existing plan.

KPIF Account Change Form

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

2026 English (PDF)

Small Business

View, download, and print commonly used forms.

Employer Forms

Consolidated Appropriations Act and Transparency in Coverage LOA

English (PDF)

Small Group List Enrollment

For new business only

English (XLSX)

Small Group Employees Confirmation Form

For renewals

2025 English (PDF) | 2026 English (PDF)

Small Group Account Change Form

English (PDF)

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

2022 English (PDF)

Broker Support Forms

Small Group Sold Group Checklist

English (PDF)

Small Group Underwriting Guidelines

English (PDF)

Small Group Termination Form

English (PDF)

Employee Assistance Program (EAP) from TELUS Health:

EAP Group Contract/ TELUS Health Subscriber Agreement
EAP Group Amending Agreement
TELUS Health EAP Launch Packet Toolkit
EAP with TELUS Evidence of Coverage

Large Business

Mid & Large business

View, download, and print commonly used forms.

Enrollment Forms

Mid Group Employee Enrollment Form with Medical Review (51-99 Employees)

English (PDF)

Large Group Employer Application

English (PDF)

Large Group Employee Enrollment & Change Form

English (PDF)

Other Forms and Support

Consolidated Appropriations Act and Transparency in Coverage LOA

English (PDF)

Individual and Family

Individual and Family forms and materials

Application

KPIF Application

Account Change Form

KPIF Account Change Form

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

Employer Forms

Consolidated Appropriations Act and Transparency in Coverage LOA

Small Group List Enrollment

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)

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

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: