Kaiser Permanente

Forms and Sales Tools

Individual and Family

Plan Information and Brochures

Sales kit items:

Enrollment Guide (PDF)

Application (PDF)

SEP Guide (PDF)

SEP Trigger Event Form (PDF)

Other items:

Washington Healthplanfinder Enrollment Guide (PDF)

Dental application for direct members (PDF)

Pediatric Dental Attestation (PDF)

Tobacco Affidavit (PDF)

The Kaiser Permanente Approach to Health Care (PDF)

Service Area Map (PDF)

Cost Share Changes and Plan Mapping (PDF)

Producer of Record Request Form (PDF)

Websites

Individual and Family Plans Member Website
(Kaiser Permanente's member website for individuals and families)

Tax Credit (Subsidy) Calculator

Washington Healthplanfinder
(Online exchange marketplace)

Premium Pay
(Website where members can pay their premium online)

Small Groups

Plan Information and Brochures

Enrollment Guide Core Plans (PDF)

Enrollment Guide Access PPO Plans (PDF)

Service Area Map (PDF)

Compare Your Plan Options: 2018 Benefits (PDF)

Adult/Pediatric Dental Benefits (PDF)

Pediatric Dental Benefits (PDF)

Access PPO FAQ (PDF)

Glossary of Health Coverage and Medical Terms (PDF)

The Kaiser Permanente Approach to Health Care (PDF)

Forms

Deductible & Out of Pocket Crediting Form (PDF)

Small Group Employer Application/Contract Renewal (PDF)

Employee Enrollment and Change Form (PDF)

Quote Request Form (PDF)

Waiver of Health Insurance Coverage (PDF)

Enrollment/Census Template (XLS)

Large Group

Plan Information and Brochures

Enrollment Guide - Core (PDF)

Enrollment Guide - PPO (PDF)

Access PPO Basic Summary Grid (PDF)

Access PPO Upfront Summary Grid (PDF)

Access PPO HSA Summary Grid (PDF)

Self-Funded Overview of Core Services (PDF)

Self-Funded Overview of Reporting and Finance (PDF)

The Kaiser Permanente Approach to Health Care (PDF)

Service Area Map (PDF)

Forms

Employee Enrollment and Change Form (PDF)

Group Master Application (PDF)

Underwriting Guidelines (PDF)

Census Template (XLS)

Medicare Advantage

Plan Information and Forms

Medicare Advantage HMO Service Area (PDF)

Medicare Advantage Part D Comprehensive Formulary (PDF)

Medicare Advantage HMO Optional Dental Benefits (PDF)

Medicare Advantage HMO Plan Election Form (Northwest Counties) (PDF)

Medicare Advantage HMO Plan Election Form (Puget Sound) (PDF)

Medicare Advantage HMO Plan Election Form (Spokane County) (PDF)

The Kaiser Permanente Approach to Health Care (PDF)

Premium Pay
(Website where members can pay their premium online)

Scope of Sales Appointment Confirmation Form (PDF)

Producer of Record Request Form (PDF)

Population Health Management

Population Health Management Brochure (PDF) 

Wellness Solution

Tips for a Successful Biometric Screening Event (PDF)

Employer Planning Checklist for Biometric Screening Event (PDF)

Biometric Screening Event Pricing Packages (PDF)

Occupational Health Services

Overview for Employers Flyer (PDF)

Injury Care at Kaiser Permanente Medical Centers (PDF)

Occupational Health Poster (PDF)

Overview for Employees Website

Other Forms

Authorization to Disclose Health Plan Info (PDF) (Printable version)

Authorization to Disclose Health Plan Info (PDF) (Interactive version)

Benefit and Prescription Claim Form (PDF)

Important Disclosure Document (PDF)

Mail-Order Pharmacy Transfer Form (PDF)

Physician Selection/Change Form (PDF)