When helping your clients enroll in a new individual and family plan during a special enrollment period (SEP) or your client needs to make a change to their existing coverage, please keep in mind:
- For new clients who are applying off-exchange, they 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.
- The Account Change Form (ACF) should be used for existing off-exchange clients who need to change plans, add or remove dependents, add or drop dental coverage, update demographics, and cancel coverage. At this time, there is not an online option to make these change and they should not be made through SMU. Some actions may require a SEP to make the change(s).
- Washington Healthplanfinder is where existing on-exchange clients can make changes to their policy or existing off-exchange clients can switch to on-exchange plans. Some actions may require a SEP to make the change(s).
- When making a plan change from off-exchange to on-exchange or vice versa, or when moving from an individual plan to Medicare, clients will proactively need to cancel their existing plan. By not cancelling the existing plan, 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 moving from an individual plan to Medicare or when moving from on to off exchange or vice versa. Your client may need to adjust an existing autopay set up to ensure autopay is pulled correctly or cancel it before their new Medicare coverage starts.
- Off-exchange clients can request cancellation by completing and sending in the ACF, by sending in writing the request to cancel, 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 their Customer Support Center.
- During Special Enrollment Period, 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 do have a limited period of 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.
Proof for SEP enrollment can be sent by mail or fax:
Kaiser Permanente for Individuals and Families
P.O. Box 23127
San Diego, CA 92193-9921
Fax – 1-855-355-5334
- Below is a reminder of the binder and premium payment timelines and grace periods:
- The Kaiser Permanente for Individuals and Families (KPIF) on-exchange binder is the first month’s premium for new members. For on-exchange coverage, the binder payment must be received either by the enrollment effective date or 30 calendar days from Kaiser Permanente receiving the application, whichever is later. If the binder payment isn’t received by the due date, the application will be canceled without beginning coverage.
- For subsequent premium payments for on-exchange KPIF members, payments are due by the end of the month before the next coverage month. If a member doesn’t pay by the due date, the following delinquency grace periods apply:
- One month for members who don’t receive financial help (Affordable Care Act advance premium tax credits or Washington Cascade Care Savings)
- Three months for members and clients who receive financial help.
- The KPIF off-exchange binder is the first month’s premium for new members. The binder payment must be received either by the enrollment effective date or 30 calendar days from Kaiser Permanente receiving the application, whichever is later. If the binder payment isn’t received by the due date, the application will be canceled without beginning coverage.
- For subsequent premium payments for off-exchange KPIF members, premium payments are due before the first of each month. If a member doesn’t pay by the due date, members have a one-month grace period.
Note: 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, Monday through Friday, 8:30am to 5pm Pacific Time.