As we get closer to the next individual and family open enrollment period, here are some reminders to please keep in mind.
Open enrollment for 2025 coverage starts November 1 and ends January 15, 2025. To obtain coverage effective January 1, 2025, Kaiser Permanente must receive a completed application by December 15, 2024.
New and existing clients may enroll or change their plan if they have a qualifying life event. Find out more about special enrollment periods (SEP) at kp.org/specialenrollment, including the various qualifying life events and what types of proof are accepted. For clients who are existing Kaiser Permanente members and are claiming a loss of coverage, coverage start and end dates can be verified and documentation should not be needed. Clients will still receive a request from Kaiser Permanente to send in documentation. If there’s a question about documentation, the Sales and Producer Support team can assist.
New clients who are applying off-exchange can enroll online through Sign Me Up (SMU) or by completing a paper application.
Sign Me Up is how you’ll process your clients’ applications. To get started, register for an account.
For existing clients who are enrolled off-exchange, the Account Change Form (ACF) should be used for certain situations, like changing plans, adding or removing dependents, adding or dropping dental coverage, updating demographics, and canceling coverage. At this time, there is not an online option to make these changes, and they should not be made through SMU. Some actions may require a SEP to make the change(s) outside of open enrollment.
Washington Healthplanfinder is where new or existing on-exchange clients can enroll or make changes to their policy. Some actions may require an SEP to make the changes outside of open enrollment.
General reminders:
- Existing clients who are moving from a Kaiser Permanente Individual and Family plan to a Medicare Advantage or group plan and whose spouse or domestic partner needs to remain on an individual plan will need to complete a NEW application — Kaiser Permanente cannot roll them over from being a dependent to the subscriber of the existing individual policy.
- Enrollment can be done online through SMU or by completing a paper application for off-exchange.
- Coverage start date is the first of the month following receipt of the completed application. If continuous coverage is needed, the application will need to be submitted before the existing individual policy is canceled.
- When making a plan change from off-exchange to on-exchange or vice versa, or when moving from an individual plan to another plan, like Medicare Advantage or employer group coverage, clients will proactively need to cancel their existing plan.
- If the existing plan is not canceled, the client will be set up on dual coverage and will be billed for both plans.
- Autopay will not automatically cancel and or adjust when a client moves from an individual plan to a Medicare Advantage plan or when they from on-exchange to off or vice versa. Your client may need to adjust an existing autopay setup to ensure autopay is pulled correctly or cancel it before their new coverage starts.
- Off-exchange clients can request cancellation by completing and sending in the ACF, by sending the request to cancel in writing, or by calling Member Services at 1-800-290-8900.
- On-exchange clients can request cancellation by selecting this option on their Washington Healthplanfinder dashboard or by contacting the Healthplanfinder Customer Support Center.
- During SEP, Kaiser Permanente Washington requires documentation to support the qualifying life event for both on- and off-exchange. Clients will receive a letter reminding them of this requirement. To learn what types of proof are accepted, visit kp.org/specialenrollment. Clients have a limited time to submit their proof for their qualifying life event. If Kaiser Permanente does not get their proof in time, we may need to cancel their application or account change, and they will need to apply again. If their 60-day special enrollment period is up, they may have to wait until the next open enrollment period.
- Binder payment/first month’s premium is due by the enrollment effective date or 30 calendar days from Kaiser Permanente receiving the application, whichever is later.
- Subsequent monthly premium payments are due by the last day of the month preceding the coverage month.
- Grace period timelines are as follows:
- Three months for clients who receive financial assistance (Affordable Care Act advance premium tax credits or Washington Cascade Care Savings)
- One month for clients who do not receive financial assistance
- Delinquency grace periods don’t apply to the first binder payment and are used when a member is late on monthly premium payments
Need support or help? Contact the Kaiser Permanente Washington Individual and Family Sales and Producer Support team at 1‑800‑474‑1079 or ifsales@kp.org, Monday through Friday, 8:30 a.m. to 5 p.m. Pacific time.