Send these 3 documents:
Mail to:
Kaiser Permanente for Individuals and Families
P.O. Box 23127
San Diego, CA 92193-3127
Fax to:
1-855-355-5334
Send these 3 documents:
Mail to:
Kaiser Permanente for Individuals and Families
P.O. Box 23127
San Diego, CA 92193-3127
Fax to:
1-855-355-5334
Call us at 1-800-475-6621 or contact your agent or broker/producer. TTY, call 711.
By submitting a signed application and proof of your qualifying life event, you’re saying that the qualifying life event happened. It’s important that we get proof of your qualifying life event. We will rely on your signature and proof to decide if you can enroll during a special enrollment period. If we determine that the qualifying life event didn’t happen, or we learn of any other inaccuracy in the information that is included in the application, Account Change Form or any other information that you submit, we may take legal action. The legal action may include but is not limited to canceling your coverage retroactively to the day it started. You may also be responsible for the full charges of any services that you received.
Need Help? Simply call: 1-800-475-6621 (TTY 711)
Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 • Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc., 1300 SW 27th St., Renton, WA 98057
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