Get Kaiser Permanente Hawaii Region Group Enrollmentchange Form

Filling out the Kaiser Permanente Hawaii Region Group Enrollment/Change Form online is a straightforward process designed to facilitate the enrollment and management of health plan membership for users and their dependents. This guide provides detailed, step-by-step instructions on completing each section of the form accurately and efficiently.

Follow the steps to successfully complete the enrollment/change form online.

1. Click ‘Get Form’ button to obtain the Kaiser Permanente Hawaii Region Group Enrollment/Change Form and open it in your preferred editor.
2. Read the instructions included on the form to understand the requirements for completion. Ensure you have all necessary personal and employer information ready.
3. Begin by completing the 'To be completed by employer' section, providing details such as company name, group number, and effective date.
4. Select an enrollment reason by checking the appropriate box. Ensure you fill in all required sections based on the reason chosen.
5. Next, complete section A for employee information. Input details including last name, first name, social security number, date of birth, and contact details.
6. Proceed to section B for family information. Add or delete dependents as necessary by providing their names, social security numbers, and dates of birth.
7. In section C, indicate whether any of the listed individuals have other coverage. Provide details if applicable.
8. Read the important information and terms outlined in section D carefully. Sign the form to confirm all information is accurate.
9. Before submitting, review the form for completeness and accuracy. Save changes and prepare to print or share the completed form as needed.

Complete your enrollment/change process online today!