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Online Account Services User ID Request Form

Need help?
California: 800-893-2971
Outside California: 866-575-3562
Email: CSC-SD-CAS-Web-Support@kp.org

When we complete processing this request form, you will receive an email with an access code that will be used to link your group information. At that time, you will need to register for a Kaiser Permanente business account and enter the access code to link your online business account to your group information.

If you already have a Kaiser Permanente online business account, you will receive a confirmation e-mail once we have linked your group information to your Kaiser Permanente business account.

The estimated processing time is 3-5 business days.

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Employer Group's Business Information

Who Completes This Form
This form is to be completed by an officer of the group health plan (henceforth referred to as "Employer Group") that has a healthcare contract with Kaiser Foundation Health Plan, Inc (KFHP).  This officer, henceforth referred to as the "Group’s Officer" in this document, must have the authority to further delegate responsibility on behalf of the Employer Group. The Employer Group can work with their KFHP account manager to identify who can act as the Group's Officer, if that has not already been established. For data security reasons, KFHP may need to verify the Group's Officer's identity.

What This Form Is Used For
If the Employer Group intends to use KHFP's online application to manage its employees' memberships in KFHP, it will need a system security administrator, henceforth known as "Primary Group Administrator."  The Primary Group Administrator will be given security privileges to then delegate access to other users to support the Employer Group.

The Primary Group Administrator must be an individual, who can be a group health plan employee or a business associate acting as an agent of the company (broker or third party administrator).

The Group's Officer will use this form to register a Primary Group Administrator.

If you need help with your Group ID(s), please contact your KFHP account manager.

User ID request type

Company business information












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Primary Group Administrator Information

The Primary Group Administrator's user ID is non-transferable. The Employer Group is wholly responsible to notify Kaiser Permanente of any changes to the Primary Group Administrator, including but not limited to the termination of the Primary Group Administrator. For each new or change in Primary Group Administrator, this form must be completed and submitted to Kaiser Permanente.

Select one of the following:


Please complete the following for the Employer Group’s employee or business associate who will act as the Employer Group/s Primary Group system Administrator for the KFHP online membership tool.










   


Group's Officer - Authorized To Submit Request





   


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