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Updated process for Off-Exchange Plan Changes

As we integrate the Kaiser Permanente for Individuals and Families (KPIF) plan services with our national services, we’re also aligning our forms and enrollment processes.

One process that we recently aligned with is the Affordable Care Act’s (ACA) policy for switching roles. Per the ACA rules, when a subscriber terminates their coverage because they’re moving to group coverage or Medicare, their dependents qualify for a special enrollment period due to the loss of minimum essential coverage. Since switching subscribers on an existing account is considered a change to the contract structure, it requires the creation of a new account. This can only happen during open enrollment or a special enrollment period. Dependents will need to submit a new application. Previously, we processed this change using the Account Change Form.

When a dependent loses their coverage due to the subscriber moving to group coverage or Medicare, they have 2 ways to complete an application for health coverage:

When applying, the dependent will select “loss of minimal essential health coverage.” Existing KPIF members don’t need proof of a qualifying life event. However, new applicants will need to provide proof of loss of coverage.

If an existing KPIF plan subscriber wants to retain coverage for only their child or children, the subscriber can use the Account Change Form to terminate coverage for themself and their spouse, if applicable, and leave the child or children on the account. The subscriber remains on the child-only account as a non-covered subscriber. In section B of the Account Change Form, the subscriber will need to select one of the following:

  • “I’m ending my coverage and I wish to keep my child(ren) on a child only account.”
  • “I’m ending my and my spouse’s/domestic partner’s coverage and I wish to keep my child(ren) on a child only account.”

If you have any questions about this process change, please contact the KPIF Sales and Producer Support team by email or at 800‑474‑1079, Monday through Friday, 8 a.m. to 5 p.m.

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