Kaiser Permanente Employee Enrollment and Change Form 2018 free printable template

Return completed form to: P.O. Box 34750, Seattle, WA 981241750 EMPLOYER: PLEASE COMPLETE THIS SECTION. Effective date Termination date Group name Group number Selected health plan Pay location (if

How to fill out Kaiser Permanente Employee Enrollment and Change

How to fill out Kaiser Permanente Employee Enrollment and Change Form

1. Obtain the Kaiser Permanente Employee Enrollment and Change Form from your HR department or the Kaiser Permanente website.
2. Fill in your personal information, including your full name, address, date of birth, and Social Security number.
3. Indicate your employment details, such as your job title and department.
4. Select the type of enrollment (new employee, change in status, etc.) and indicate the coverage type (individual, family, etc.).
5. Provide information about any dependents you wish to enroll, including their names, dates of birth, and Social Security numbers.
6. Specify any additional benefit options or changes you wish to make, if applicable.
7. Review the form for accuracy, ensuring all required fields are completed.
8. Sign and date the form to certify that the information provided is correct.
9. Submit the completed form to your HR department or follow the specified submission instructions.

Who needs Kaiser Permanente Employee Enrollment and Change Form?

1. Newly hired employees seeking health coverage.
2. Current employees making changes to their existing health coverage.
3. Employees who have had a qualifying life event impacting their health benefits.
4. Dependents who need to be added or removed from the health plan.

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What is Kaiser Permanente Employee Enrollment and Change Form?

The Kaiser Permanente Employee Enrollment and Change Form is a document used by employees to enroll in, change, or update their health care coverage and related benefits provided by Kaiser Permanente.

Who is required to file Kaiser Permanente Employee Enrollment and Change Form?

Employees who are enrolling in Kaiser Permanente health plans for the first time, making changes to their existing coverage, or updating their personal information are required to file the form.

How to fill out Kaiser Permanente Employee Enrollment and Change Form?

To fill out the form, provide all required personal information, select the desired health plans, indicate any changes to current coverage, and ensure all fields are completed accurately before submitting it to the appropriate HR or benefits office.

What is the purpose of Kaiser Permanente Employee Enrollment and Change Form?

The purpose of the form is to facilitate the enrollment process for employees and to ensure that their health care coverage accurately reflects their needs and circumstances.

What information must be reported on Kaiser Permanente Employee Enrollment and Change Form?

The form typically requires personal information such as employee name, address, date of birth, social security number, and details about dependents, as well as selections regarding health plan options and any changes to existing coverage.