Get Enrollment And Change Form - Broker Support - Kaiser Permanente - Brokernet Kp

This guide offers a clear and structured approach for completing the Enrollment And Change Form associated with Kaiser Permanente. By following these steps, users can effectively manage their enrollment and changes to their health plans.

Follow the steps to complete the Enrollment And Change Form online.

1. Press the ‘Get Form’ button to access the Enrollment And Change Form and begin the editing process.
2. Identify the sections of the form. The Enrollment And Change Form is divided into various sections, including employee information, coverage waiver, family information, dependent details, and other coverage information.
3. In Section A, enter your personal details. Provide your full name, social security number, date of birth, and indicate your primary care provider.
4. Proceed to Section B to waive coverage if applicable. Select any coverage you are refusing and provide a reason if necessary.
5. For changes in dependent status, complete Section C. Add or delete dependents by providing their names, birth dates, and any necessary medical record numbers.
6. If any listed dependents exceed maximum age or are disabled, complete Section D with relevant information.
7. Use Section E to provide addresses for any dependents living at a different permanent address. Include detailed information as required.
8. In Section F, indicate if you or your dependents have other health coverage. Provide details on any additional insurance coverage held.
9. Finally, in Section G, review the form carefully, ensure all sections are filled out correctly, and provide your signature and the date to affirm the information's accuracy.
10. Once all steps are completed, review the entire form for completeness. You can then save your changes, download, print, or share the form as required.

Start completing your documents online today to ensure timely processing and enrollment.