Kaiser Permanente Employee Enrollment and Change Form 2020-2025 free printable template

KAISER PERMANEISTTE Return completed form to 2020 Employee enrollment and change form P. O. Box 34750 Seattle WA 98124-1750 EMPLOYER PLEASE COMPLETE THIS SEQION. Effective date Original date of hire / /. Date of rehire Termination date Date transferred from part time p/t to full time f/t Group name Group number Hours worked per week Selected health plan D open enrollment I I New employee D Add dependent s D Remove coverage Employee Address/name change Start date / 18 months n 36 months n...

How to fill out kp employee enrollment form

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 their website.
2. Review the form requirements and gather necessary personal information (e.g., Social Security number, date of birth).
3. Fill out your personal details in the appropriate sections, including name, address, and contact information.
4. Specify your employment details, including job title, department, and employee ID.
5. Indicate the type of enrollment or change you are requesting (e.g., new enrollment, adding a dependent, changing coverage).
6. Complete the section related to dependents if you are enrolling family members and provide their personal information.
7. Review your completed form for accuracy and ensure all required fields are filled out.
8. Sign and date the form to certify that the information provided is true and complete.
9. Submit the form to your HR department by the specified deadline.

Who needs Kaiser Permanente Employee Enrollment and Change Form?

1. All employees of Kaiser Permanente who are eligible for health benefits.
2. Employees who wish to make changes to their current health coverage.
3. New hires needing to enroll in health insurance upon starting their employment.
4. Current employees adding dependents to their health insurance 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 or make changes to their health insurance plans offered by Kaiser Permanente.

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

Employees who are newly eligible for health insurance coverage, those who are experiencing life events such as marriage or the birth of a child, and current employees wishing to make changes to their existing coverage are required to file this form.

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

To fill out the form, employees must provide personal information such as name, address, date of birth, and Social Security number, as well as details regarding their current and new coverage options. Instructions are typically included with the form to guide the employee through the process.

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

The purpose of the form is to collect necessary information from employees to facilitate enrollment in health plans and to document any changes that need to be made to their insurance coverage.

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

The information that must be reported includes the employee's personal details, current health plan coverage, any changes being made (such as adding or removing dependents), and any relevant life event that may affect insurance eligibility.