Individual and Family

• Plan Information and Brochures

  2019 Individual and Family Commission Supplement (PDF)

  2019 Service Area map (PDF)

  Sales Contacts for Producers (PDF)

  Individual and Family Enrollment Guide and Rates (PDF)

  SEP Guide (PDF)

• Forms

  Account Change Form (PDF)

  Affidavit of Non-Tobacco Use (PDF)

  Attestation of Pediatric Dental Coverage (PDF)

  Dental Application (PDF)

  Enrollment Application (PDF)

  SEP Documentation of Triggering Event Form (PDF)

  Agent of Record Form (PDF)

• Websites

  Individual and Family Plans Member Website (Kaiser Permanente's member website for individuals and families)

  Tax Credit (Subsidy) Calculator (Website)

  Washington Healthplanfinder (Online Exchange marketplace)

Small Group

• Plan Information and Brochures

  The Kaiser Permanente Approach to Health Care (PDF)

  Rating Area Map (PDF)

  Getting Care with Core/Kaiser Permanente Plans (PDF)

  Getting Care with Access PPO Plans (PDF)

  Access PPO Key Providers (PDF)

  Access PPO FAQ (PDF)

  Compare Your Plan Options (PDF)

  Glossary of Health Coverage and Medical Terms (Brochure)

• Forms

  Group Master Application (PDF)

  Enrollment/Census Template (XLS)

  Employee Enrollment and Change Form (PDF)

  Deductible & Out of Pocket Crediting Form (PDF)

  Request a Quote (PDF)

  Employee Enrollment Form and Employee Waiver (PDF)

  Waiver of Health Insurance Coverage (PDF)

Large Group

• Plan Information and Brochures

  Access PPO Upfront Benefits Summary (PDF)

  Access PPO HSA Benefits Summary (PDF)

  Access PPO Basic Benefits Summary (PDF)

  HMO Benefits Grid (PDF)

  HMO HealthPays HSA Benefits Grid (PDF)

  Access PPO Basic Benefits Grid (PDF)

  Getting Care with Core/Kaiser Permanente Plans (PDF)

  Getting Care with Access PPO Plans (PDF)

  Getting Care with Access PPO Spokane Plans (PDF)

  Getting Care with Access PPO Puget Sound Plans (PDF)

  Service Area Map HMO (PDF)

  Service Area Map PPO (PDF)

• Forms

  Group Master Application (PDF)

  Employee Enrollment and Change Form (PDF)

  Census Template (XLS)

Medicare Advantage

• Forms

  MA Commission Supplement (PDF)

  Medicare VP Placemat (PDF)

  Sales Contacts for Producers (PDF)

  Medicare Advantage Part D Comprehensive Formulary (PDF)

  Star Rating Flyer (PDF)

  Medicare Advantage HMO Optional Dental Benefits (PDF)

  Enrollment Form (PDF; CMS requires that potential enrollees receive a Summary of Benefits and Star Ratings Document when given an Enrollment Form)

  Service Area Map (PDF)

  Scope of Appointment Form (PDF)

  Summary of Benefits Vital, Essential, Optimal (HMO) (PDF)

  Summary of Benefits Harbor (HMO) (PDF)

  Summary of Benefits Centennial and Columbia (HMO) (PDF)

  Summary of Benefits Basic (HMO) (PDF)

  Summary of Benefits Key (HMO) (PDF)

  Agent of Record Form (PDF)

• Websites

  Premium Pay (Website)

Other

• Occupational Health Services

  Overview for Employers Flyer (PDF)

  Overview for Employees (Website)

  Occupational Health Poster (PDF)

  Injury Care at Kaiser Permanente Medical Offices (PDF)

• Other Forms

  OptumRx Pharmacies (PDF)

  Mail Order Pharmacy Resource Card (PDF)

  HSA Preventive Medication Flyer (PDF)

  OptumRx Claim Reimbursemet Form (PDF)

  Secure E-mail/Gateway Instructions (PDF)

  Physician Selection/Change Form (PDF)

  Important Disclosure Document (PDF)

  Benefit and Prescription Claim Form (PDF)

  Authorization to Disclose Health Plan Info (PDF)